‘Everyone needs love’ – an interview study about perceptions of love in people with intellectual disability (ID)

Abstract How do people with intellectual disability (ID) perceive love and its role in their lives? The purpose of this study was to give voice to people with ID themselves and provide information about their needs for love. The study analysed how seven Finnish young adults with mild ID (5 women and 2 men) aged between 18 and 31 years described love and the meaning of love in their lives in semi-structured, qualitative theme interviews. The analysis was theory-led content analysis. The findings showed that the young adults with ID could describe love primarily as emotions and concrete acts, but perceived love as knowledge and skills more difficult to describe. However, the meaning of love was considered crucial and important for everyone’s well-being. The study suggests that the views and opinions of people with ID should be given more attention so that the support and guidance they are given would better need their needs. In addition, the study highlights everyone’s right to love? As per the style. Please suggest.

showed in practice. Love acts include, for example, appreciation and thanking the other, caring and interest, support and empathy, ability to share everyday life and pay attention to the other, as well as the commitment in the relationship. Love as knowledge and skills refers to the cognitive side of love: the actual skill of love necessitates problem-solving and interaction skills, ability to tolerate adversities and solve disagreements, sexual skills (in romantic love), sense of humour, patience and self-appreciation. Knowledge and skills are those cognitive abilities that help igniting and maintaining love.
People form their conceptions of love in relation to those models, rules and expectations they have been provided with by previous generations in their cultural environment. It means that information about love is received directly from others or by interpreting practical situations in the light of one's values, norms and knowledge about love. People with ID have limited functional abilities when evaluated from the norms set by society. Therefore, the way ID is seen is greatly tied to the society one lives in. Certain norms, values and attitudes prevail in every society and they determine how people with ID are seen as members of society. one's diagnosis is not the only important determining factor, but the general willingness of accepting and supporting participation and self-determination matters as well.
When defining ID, we have to analyse our own conception of human being and people with ID. However, the conception of a human being does not directly determine how people with ID are perceived and treated by society. It merely provides the guidelines and foundation for work with people with ID. Taken this complex background, research on love in the lives of people with ID has focused on certain, limited themes. For example, studies have analysed their right to dating (Ward, Atkinson, Smith, & Windsor, 2013), getting married (Shaman, 1978) and parenting (Vogel, 1987). Likewise, the number and special features of marriages between people with ID have been researched (Floor, Baxter, Rosen, & Zisfein, 1975;Koller, Richardson, & Katz, 1988), as well as acceptance of these marriages (oliver, Anthony, Leimkuhl, & Skillman, 2002;Taylor & Bogdan, 1989).
What people with ID think about love has been less studied. Lee and oh (2013) noted how in their South Korean sample, major challenges to maintaining a happy marriage were related to financial demands such as securing sufficient household income, finding assistance in performing housework and improving relational quality among family members. In another study, Mayes and Llewellyn (2012) gave voice to mothers with ID who have children in care and who suggest that their support needs may differ from each other and over time (see also Llewellyn et al., 2003). Serious concerns are being raised about the unusually high rate at which their children are removed from their custody (McConnell & Llewellyn, 2002).

Method
The purpose of this study was to research how people with ID perceive love and bring out their own way of defining love and its meaning, from their own perspective. The two main research questions set for this study were as follows: (1) How do young adults with ID define love?
(2) How do young adults with ID perceive the value and meaning of love in their lives?
To answer these questions, seven Finnish young adults with ID (5 women and 2 men) aged between 18 and 31 years were recruited in the study. They are referred to with codes W1, W2, W3, W4, W5, M1 and M2, where the letter 'W' means a woman and the letter 'M' means a man, and the number distinguish the participants from each other. each participant had diagnosed with mild ID, and they were considered capable of participating in the study and describing their perceptions and opinions of love. MR or ID is divided into four levels that are mild, moderate, severe and profound. often, medical literature uses two-level division of mild and severe ID. In the latter, IQ is less than 50, while IQ of 50-69 means mild ID.
Among people with mild ID, the ability to understand and use language is retarded but most of them learn sufficient ability to speak so that they can cope in the everyday life (Buntinx & Schalock, 2010). Most of them can take care of them independently: they can feed, dress and wash themselves and know how to do household work. Some of them may be able to work in a job that does not require education. However, they usually need constant guidance and surveillance in their work. People with mild ID have great problems with education, and many of them have difficulties in reading and writing. Indeed, people with mild ID usually need special education. If mild ID includes recognizable emotional and social immaturity, one may be incapable of starting a family and raise children. However, people with mild ID can live alone or with little support when adults. They often need support to get the social services they need. Their ability to use and handle money can be insufficient and, due to their naivism, they can get abused and misled by other people. In general, many adults with ID are able to maintain good social relationships.
Based on the aforementioned, the selection of a suitable research method was crucial. To find out the young adults' perceptions of love, their own opinions and possible experiences, interview was considered the only way (see also Booth & Booth, 1994). The participants recruited in this study had relatively good interaction skills, which was considered as the condition for participating in the study. They were found via a support centre for people with ID. each of them received an interview permission form that included a short introduction of the research and its purposes and methods. The participants were allowed to familiarize with the form in peace and ask further details if they wanted. everyone who was invited to participate in the study accepted the invitation with great interest and enthusiasm.
This was a qualitative study in which the participants were personally interviewed with a semistructured interview method. The interview consisted of two main themes: falling in love and love. In this study, it was crucial to compile an interview guide that would serve the purposes of the study and that would be understandable for the participants. every participant answered the same questions that were open-ended. This was to encourage the participants to describe openly their own experiences and perceptions, talk about their own viewpoints and opinions. According to the idea of a themed interview (Gubrium & Holstein, 2002), the researcher can change the order of questions during the interview if necessary. In addition, it was considered important to be able to rephrase the questions if the interviewee would not understand them as they were and to ask supplementary questions when needed.
The data were analysed with theory-based qualitative content analysing method. It means that the analysis was deductive and the framework of analysis was based on previous findings and theorizations of love (Tuomi & Sarajärvi, 2009). This kind of analysis uses an existing framework to categorize the data. However, the categories have to be conceptually and empirically well reasoned. In this study, Määttä and Uusiautti's (2014) (Uusiautti & Määttä, 2012) definition of love as a three-dimensional phenomenon formed the basis of data analysis and categorization. The categorization gives room for various types of experiences and descriptions of love and was, thus, considered functional for the purposes of this study. The data were systematically categorized into these categories which then were analysed as entities. The following data excerpt illustrates how the interview data were categorized in this study: Love as emotions: 'Well, the feeling that I love them. ' Love as acts: 'Someone would bring the breakfast in bed, and I would do household work, and he would coddle. '

Love as described by young adults with ID
In this study, the descriptions of love were categorized into three elements: love as emotions, love as acts, and love as knowledge and skills. next, these elements are introduced followed by the participants' perceptions of the significance and value of love in their lives.

Love as emotions
Love as emotions was described as a very important area of love. Five young adults with ID discussed the emotions of love during their interviews. They perceived emotions as a natural part of love, and, without exception, these emotions were positive. However, it was noteworthy that the participants did not distinguish separate emotions per se but defined love itself as an emotion. The young adults with ID had also noticed that love can influence other emotions. They emphasized the positive influence love has in life and described how love can improve the quality of life. one of the interviewees emphasized the significance of love-related emotions as a part of the entity of love. He reported that the practical feelings of love are more important than, for example, information about love or being loved.
Well … Wait a second … I guess the feeling of love is more important to me. (M2) Positive emotions and their influence on general well-being were noticed and described, for example, as follows: Well, everyone is happier then, when you have these friends. So that you do not have to be alone. (W2)

Love as acts
Love as acts was an element of love that was easy to define and recognize. everyone could describe acts that manifest love based on their own experiences. Some of the interviewees also brought out acts that they would hope or imagined to illustrate love. What was common to these experiences, hopes and dreams was their concreteness and modesty -in other words, they were very practical, everyday acts. The interviewees were asked to describe, for example, how they would show their love toward another person. The answers included following examples: At least I say hello. At least I let him kiss me. I look in the eye. (W3) Tenderness, caring … touching. Those basic things. (W4) The interviewees also described various acts of love they had encountered or received. They were quite concrete by nature as well. The acts showed intimacy and caring. In addition to everyday, simple acts of love, the young adults talked about romantic gestures that were clearly learned from the environment. These kinds of romantic acts of love were among others gifts given to a woman by a man. The following excerpts illustrate how the young adults with ID described acts of love: Well they have been much nicer to me than to other girls … (W2) When he [a boyfriend] has been blue I have hold him, and if I have been blue, I could go and cry in his lap. (W4) once one boy gave me chocolate. It even had heart-shaped chocolates! -And then, I got even flowers from another boy! (W2) Hmmm … I could go on my knees. or give her for example a ring or a rose or something. (M2)

Love as knowledge and skills
everyone interviewed in this study reported that they had received information about love from some outside source. Most of them had discussed about love with their families and friends. other sources of information mentioned in interviews were school, teachers and peers at school. However, most of the interviewees were unable to describe the information in detail. In other words, they had the experience of getting information but they could not, for some reason, describe it in words. one of the interviewees mentioned information provided by the media. Yet, this interviewee told that information from the TV was not directly about love but the interviewee had concluded that the action described in TV was about love.
In all, knowledge about love is not based on just one source of information. They received and construct their knowledge constantly. All information combined with personal experiences result in a unique conception of love.
When talking about love skills, the interviewees emphasized abilities to tolerate and handle adversities and conflicts, interaction and problem-solving skills, and the ability to share everyday life. The most important skill was interaction that included presence and attention. They mentioned skills such as being romantic, tenderness and listening the most often during the interviews.
He [a boyfriend] is so calm, and then, he listens … -And I can talk to him. (W5) We would talk and date, and that would be the kind of manifestation of love that I need. And then again, more of that tenderness … (M2) The young adults with ID mentioned that presence in interaction was especially important. It seemed that being able and willing to notice the other one's need for support was an important part of love skills. During difficult times or adversities, they wanted to keep their loved ones close, and also be there for them when needed. They also wanted to share their moments of joy with the other and considered that the presence of special people promoted their well-being. everyday life together and shared experiences were considered important in every interview. The importance of doing things together was emphasized. Time and effort were considered directly relational to the quality and length of the relationship. However, the interviewees mentioned the meaning of maintaining their own identities in a romantic relationship, as well.
We could go to gym together and do something else together too. --However, I guess I think that we should not be together all the time. Both could go with their own friends too every now and then. --Surely, both want their own time as well. (W2)

The value and significance of love in the lives of young adults with ID
The influence of love in life was described only as positive. The young adults longed for love, talked about it with warmth, and expressed great interest and enthusiasm toward it. The presence of surrounding people was perceived meaningful, and love was defined even as the prerequisite of good life: Well, it is nicer than being alone. everyone should have some friends so that they would not have to be alone. When discussing about the necessity of love in one's life, the interviewees were of the same opinion and answered without any hesitation: love was seen as a very important and necessary part of life. In addition, it was mentioned to be every human being's right. I think everyone needs love. no one wants to be without any friends or family or a boyfriend. everyone should have someone. (W2) Love was perceived crucial to well-being. It was described as an empowering experience and strength maintaining life. Support, safety and attention received from the loved one made the research participants feel themselves as meaningful individuals. Life was easier and more significant when one could share it with someone. The need for love was perceived partly situational: everyone needs love but it depended on the person, situation and level of love needed. Some of the interviewees clearly thought about the general need for love in human beings' lives and contemplated everyone's coping and well-being. others discussed more about individuals' need for love. They contemplated from who and how much love they themselves needed. Mostly, their attention focused on romantic love.
When thinking about the future, everyone hoped they would have love in their lives. Those who already had a romantic relationship believed their love will last. Hopes and wishes were targeted mostly on romantic love. Love with the existing partner was hoped to last and grow, and those who did not have one, hoped they would find the right one.

Summary and conclusions
According to the findings of this study, the young adults with ID understand love very concretely. one of the most important findings was how positively they all perceived love and its importance in their lives. Love was considered important and valuable to themselves and to people in general as it was recognized as a crucial element of well-being.
The interviewees mentioned that love-related positive emotions were the sense of togetherness, happiness and trust. It was interesting to find out that they discussed about love as a combination of various positive emotions and love as an emotion itself. The latter was described as a positive feeling that dwells inside and causes good mood and happiness. The emotional side of love was considered the most important of the three elements analyed in this study.
Love as acts was described in a very concrete level. The young adults with ID could talk about this element of love more easily than about love as emotions because they could connect it with certain personal experiences or situations they had seen and interpreted as acts of love. Most of the acts they described were related to everyday interaction and attention paid on the partner, such as talking about feelings, good behaviour, honesty, listening and intimacy (e.g. hugging). other important daily acts were being present and supporting the other, especially in difficult situations. every participant reported that they had received information and learned about love, but they all seemed somewhat unable to describe their knowledge. Instead, they considered practical love, practical experiences more important. When the young adults with ID described skills that are important in love, they emphasized interaction skills and the ability to share the everyday life. From the point of view of interaction, special skills of romantic gestures, tenderness, talking, listening, presence and attention were mentioned, which are merely acts. Commitment to them was considered an important love skill.
on the other hand, their answers reveal that, in this data, it was difficult to clearly distinguish descriptions of love as acts from love as knowledge and skills. While acts are, indeed, concrete manifestations of love that are something without which one cannot know that the other loves. We show our love by our acts and behaviours. However, love as skills and knowledge refers to more general, cognitive skills that are important for maintaining and nurturing love, such as sense of humour, communication skills, problem-solving skills, self-regulation and so on (see Määttä & Uusiautti, 2014). Based on the research, the young adults with ID in this study showed that they understood love as emotions and acts, but not so much as actual knowledge and skills as they are defined in Määttä and Uusiautti's (2014) theory (see also Uusiautti & Määttä, 2012). As this was a qualitative study, the findings cannot be generalized, but the study implies that the area of love that is the most closely connected to one's cognitive abilities (love as knowledge and skills) remained the most distant or weakest in the descriptions of the young adults with ID. While Määttä and Uusiautti's theory represents the three elements of love equally important, could love in the lives of people with ID be shaped differently so that the emotional element and love as acts are given more emphasis.
When evaluating the reliability and ethical viewpoints of this study, several important viewpoints must be acknowledged (see also Uusiautti & Määttä, 2013). First of all, we have to analyse the participants' ability to discuss love (Booth & Booth, 1994;Finlay & Lyons, 2001). How well did they understand the questions and could some other method have provided more reliable information? Their ID had to be noticed when planning and conducting the interviews. The interviewer had been working with people with ID earlier and thus was capable of interacting and paying attention to the special requirements of the interview situations. In addition, the questions were formed so that it was easy to rephrase them whenever needed in the interview. It seemed that the participants were able to answer the questions and were also happy to talk about their own experiences of and opinions on love. The interview situation did not cause harm or frustration in any of the participants and they were reminded that they could withdraw from the study any time.
However, even if the interviews were planned carefully, it is still relevant to discuss how truthfully the participants were when talking about love. Love is a theme that is difficult to approach by anyone because of its personal nature. even a research participant with the so-called normal IQ can find it difficult to describe his or her deepest emotions, thoughts and experiences. The interaction and communication skills of people with ID are tested especially when they are asked to discuss themes that they do not usually talk about or have no previous experience of, or that they find difficult to perceive. In addition, they may find it difficult to talk to someone they do not properly know beforehand -in this case, the interviewer -as do most of the people, especially when asked about personal matters. Another important question is, to what extent, the young adults with ID mixed their hopes and expectations with their actual experiences and opinions (e.g. Hatton et al., 2015). In general, people's perceptions differ from each other based on their earlier experiences. In this study, the participants were not asked about their past experiences of love and falling in love. But, as the purpose was to obtain information about the perceptions of love in people with ID, the interview method seemed to produce relevant data, which allowed the participants to express their thoughts in their own words. For example, some other methods (e.g. a questionnaire) would not have been reasonable, nor could the young adults' opinions be brought out by asking about them from any other people than the youngsters themselves. Indeed, Booth and Booth (1994) emphasize that 'interviewing can provide new knowledge not accessible through other methods of data collection, and offers a way of giving people with learning difficulties a voice in the making of their own history' (p. 415). The way the interview was conducted paid attention to the problem of acquiescence in quality-of-life interviews with people with ID (Matikka & Vesala, 1997; see also Finlay & Lyons, 2002). By using open-ended questions and allowing the participants to use their own words, giving them time to answer, the purpose was to reach their voices as authentically as possible.

Discussion
The study showed how important love is and how closely it is tied to well-being among people with ID as well. Likewise, the study showed that love was defined by the young adults with ID in the same way as previous love theory by Määttä and Uusiautti, 2014 (see also Uusiautti & Määttä, 2012) suggests. According to the theory, love and the ability to love can be compared to human virtues as defined by Seligman, Steen, Park, and Peterson (2005). According to this viewpoint (see also Seligman, 2002Seligman, , 2011, love means deep caring for others and it makes life worth living. In other words, love is an emotion of strong affection and personal attachment. Furthermore, love can be seen as a virtue or strength representing human kindness, compassion and affection (e.g. Seligman et al., 2005), and, thus, promotes health and well-being in life (Wärnå, Lindholm, & eriksson, 2007). In people with ID, love at its best appears as a phenomenon that covers those emotions, knowledge, attitudes, acts and decision-making that typify the ability to love.
How do the perceptions of love become realized? When analysing the societal participation of people with ID, it is clear that they need various support in their everyday lives (e.g. McPhedran, 2011). People with ID face numerous challenges in their daily life, and they need help to cope with them. However, their need for support does not directly mean that they would not be capable of any kind of independent activity. As the study showed, the young adults with ID had their own thoughts and opinions, and appeared as individuals in this study. Therefore, it might also be relevant to ponder whether the support they receive is the right kind. Are we able to truly support their own, individual needs, desires and thoughts without categorizing them into some predetermined category and blanking out their own will and individuality?
More attention should be paid on means of supporting the independency and individuality of people with ID (Robertson, Hatton, Baines, & emerson, 2015). As the literature review showed, they are being ignored in research; they are studied but not heard. This study wanted to give voice to people with ID and highlight their own thoughts and emotions, perceptions and experiences, without prompting or moulding their answers. From this perspective, the purpose was also to represent as subjects, as equal members of society (McPhedran, 2011).
When dissecting more closely the contribution of the research in the field of social psychology and love research, the study supported earlier findings about the importance of intimate and close relationships for human well-being (see e.g. Berscheid, 2006). Also, the young adults with ID perceived love important, even as a fundamental part of life (see Lee & oh, 2013). It was connected with interaction, intimacy, support and safety that all were seen empowering factors that promote well-being in everyone's life. While all the theoretical descriptions may give impression of love as an exaggerated supernatural power, the practice proves otherwise: for example, the young adults with ID emphasized the simple acts of love that show, at their best, one's care, support, and attention toward the loved one (see also Lumley & Scotti, 2001).
Attention and support can make one feel important and influence positively on mental well-being, including self-esteem (see e.g. Hewitt, 2009). That makes an important area of one's overall well-being. especially among people with ID, positive, supporting interaction, in other words, positive and close relationships are especially important means of supporting their well-being (Ipsen, 2006). As the study showed, the young adults with ID understood love in many ways. Regardless of the form of love, everyone deserves the experience of being loved. Indeed, according to Dykens (2006) (see also Dykens, 2005), research on people with ID have succeeded in some arenas but failed to address happiness and well-being in a comprehensive manner. This study contributed one perspective to this discussion by presenting information about how people with ID themselves describe love and its meaning in their lives. When developing support and guidance for people with ID (see e.g. Lumley & Scotti, 2001;Plaute, Westling, & Cizek, 2002), it is necessary to hear their own voices and adjust support to meet their personal, unique needs.

Disclosure statement
no potential conflict of interest was reported by the authors.

Notes on contributors
Jenni Mattila, MA, is a school teacher and has graduated from the University of Lapland, Finland. Her research interests focus on people with intellectual disability, their identity development and love and relationship skills.
Kaarina Määttä, PhD, works as Professor of educational Psychology and a vice-rector at the University of Lapland, Rovaniemi, Finland. Her research interests include caring teacherhood and teacher training, the pedagogy of supervision of doctoral theses, love and human relationships as well as positive psychology and human resources.