Dear doctor: A letter from a survivor of sexual trauma to all medical professionals

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Dear Doctor,

As a medical professional you have taken an oath to do no harm, but there are ways in which you can hurt your patients without even recognizing you are doing so. What seems to you as a simple exam may cause injury to those who have been victimized by someone’s touch. This is a subject that we, survivors of sexual violence, have been meaning to discuss with you for some time now, but your authority can be more intimidating than you may know. I am also unsure if you are aware just how much power you, as a physician, hold and to the extent that you affect the lives of all of your patients. Your interactions with us travel much deeper than the physical core.

The relationship between patient and doctor is also mental, built on trust, understanding, and the security of knowing that your doctor has your well-being at heart. We, as your patients, entrust in you the most intimate parts of our bodies and our lives. But this trust has to be earned, and it is much harder for us patients who have been so severely violated. The intent of this letter is not to in any way criticize your work as a physician, but to better inform you of the needs of this specific group of patients.

Survivors of sexual abuse suffer in ways that only others who have been victimized can truly relate to. Once the assault is over in the eyes of those around them, it still continues for the victims. Like many soldiers who come home from war, those who have been sexually assaulted are prone to develop PTSD. This disorder causes frequent and unpredictable flashbacks and body memories. Those of us living with PTSD have no control over its occurrence or its impact on us. Anything can trigger it: touch, an image, a word, even a smell. Flashbacks are not like basic memories; when they happen we relive the attack as vividly as if it were truly reoccurring. Everything our bodies felt, they feel again and we respond to it involuntarily. Our fight, flight, or freeze reactions are activated and we may lash out, hastily leave, or close ourselves off  all together. It is both emotionally and physically disabling for us to endure.

As a doctor of physical, and not mental health, you may be wondering how this information concerns you. You play a large role in our healing as well. By being forced into sexual acts, touch has been turned into something painful and hands have become a weapon. For many of us, the feel of touch is no different than a hot iron being pressed into our skin. The notion of being touched in itself is threatening, which makes a visit to your office feel like we are intentionally harming ourselves. We are essentially throwing ourselves into the snake pit. We know that we will be re-traumatized to some extent and we come to you already anxious and afraid, but how you act toward us is the determining factor of how we will react to you. If we choose to confide in you it isn’t us seeking to be coddled, but seeking your understanding and empathy. For us to allow you into our bodies you need to first be let into this tragic part of our lives. You need to understand what we went through if you are to be able to respect our boundaries and limitations.

When we walk into the examination room, our hearts start to race and breathing feels difficult. More than anything all we want to do is turn around and run. When you tell us, “Remove your clothing,” we start to shiver and we cling to the fabric, our only protection from wondering eyes and fingers. Our nakedness brings about the feelings of shame and vulnerability.

Cognitively we know you are not our attacker, but when you reach to touch us your hands become theirs. You become them. We may pull away or make you stop as our personal assault begins to play out within our mind. Our brain sends signals to every nerve ending in our body, relaying that the sexual assault is happening again. Gynecological exams are especially prone to this. A speculum being inserted into the vagina when a survivor is in the throes of a PTSD episode is equivalent to the penis of her rapist penetrating her.

It is important to remember that survivors come from all races, religions, and age groups. The sad reality is that no statistic can accurately portray the number of individuals who are sexually assaulted each year. The number of reported incidents is staggering, but the number of unreported is even higher. So, no matter where or who you treat, you are likely to come into contact with a number of survivors during the course of your career.

While most of the focus when it comes to sex assault is on adult women, we mustn’t forget the much younger victims of both sexes. It is estimated that, for children under eighteen, one in four girls and one in six boys are sexually assaulted or abused. For this reason I feel it is a necessity for doctors, especially pediatricians, to know the signs that a child has been or is being sexually abused. Doctors can often pick up on physical signs of abuse such as bruises and broken bones, but may miss the physical signs of sexual abuse if they are not specifically being looked for.

This makes behavioral and developmental markers invaluable. Some of these signs include appearing overly compliant or aggressive, anxiety, fear or avoidance of touch, and speech or learning disorders, just to name a few. Having the ability to pick up on the signals a child victim gives off could save their life and countless others from going through the same ordeal. It can be as simple as keeping pamphlets on hand in your office and having yourself and staff read over them periodically. If you suspect abuse, do not be afraid to ask questions or report it. Children cannot remove themselves from dangerous situations and it is the responsibility of all those who interact with a child to be that child’s voice.

I can’t even begin to count the number of times I personally have had my needs as both a child victim and an adult survivor neglected by a medical professional. Some actions were made out of pure cruelty, but most out of a lack of knowledge regarding what traumatic events inflict upon their victims beneath the physical wounds. To be honest with you about what has happened to us is profoundly re-traumatizing, but we take this risk  and the hurt numerous times in hopes that if we explain our situations to you, that you will be patient and gentle with us.

It is a devastating blow to go through our victimization again just to be shrugged off or to have our doctors act like our disabilities are inconveniencing them. The treatment we receive from others after our sexual assaults, including our doctors, can be just as traumatizing for us as the assault itself was. The attack left us in our lowest low. Many of us have no confidence or self worth. We require the support and reassurance of others to help us overcome what has been done to us. Without someone in our corner fighting with us, it is extremely difficult, if not near impossible for us to recover.

Doctors are a necessity in the lives of everyone, but you are even more valuable to us survivors. You may be the first person we allow to touch our bodies after they have been desecrated by another’s hands. It is terrifying, shameful, and a very painful experience. In those moments, some of our most vulnerable, we need your patience. We need kind and honest words in a gentle tone, and we need a slow and understanding touch that is safe for us to say no to.

You have the ability to give us power back that was taken from us and that little bit of power can make a world of difference while we tread this road. When you take the time to listen to us and learn what we need from you as our physician a mutual respect between patient and doctor grows. You taking the time to listen to us tells us that you truly care about us and the treatment that we receive from you. These simple yet meaningful acts allow us to build trust in you when trust can be difficult to manage. When we are able to build trust in you and trust in your touch, that opens the door for us to allow others in as well and it all starts with you.

Sincerely,

Carol Chandler
Survivor

30 responses

  1. Pingback: We Must Listen To Sexual Misconduct Victims - OTBS: Only The Brand Survives

  2. Carol, Thank you so very much for sharing this post, it’s really resonated with me as it’s something that I still continue to struggle with and I am sure that so many other survivors do as well. I am a social worker and run a free online resource for female survivors of sexual trauma and relationship abuse, with your permission I would love to repost this article for our community, would that be possible? The website is http://iamarockstar.me

    Liked by 1 person

      • Hi Carol, I work for The Dr. Oz Show. We would love to speak with you about your story and spread the word about this issue. If you are interested in speaking with us please email me at ecasey@zoco.com to see if we can help spread the word.

        Thank you
        Emily Casey

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  7. Thanks so much for writing this, it mirrors my experiences as a GP working with so many vulnerable patients who were sexually abused as children. I’ve been writing about it here https://abetternhs.net/2016/11/21/shame-and-redemption/ (for example) and have helped set up a course on shame for medical students at UCL (in London). There’s project called shame and medicine which I’m involved with http://www.shameandmedicineproject.com/ trying to bring shame into the medical curriculum – and I’ve invited Daniela Sieff to join us http://www.danielasieff.com/ because of her work on trauma. It’s rare to get first person accounts of what it is like to be on the receiving end of care from people who have suffered abuse and this is so valuable and we would love to share it with our students and colleagues. Any other thoughts, ideas or experiences you might have would be very warmly welcomed,
    Jonathon

    Liked by 1 person

    • Yes, please feel free to share my letter. I have hoped that it could and would be used as a teaching tool. I apologize for the delay in my response. Your comment and another only reached me today.

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  8. Carol- Thank you very much for posting your letter. I am a forensic nurse who will be giving a presentation in April to other health care providers on “Trauma-informed care of the sexual assault patient”. Do you mind if I share your letter during the presentation? Your words are powerful and will be very helpful in emphasizing the importance of trauma-informed care across the continuum of care for survivors.

    Liked by 1 person

  9. Pingback: Trauma informed | Out of the Rabbit Hole

  10. Pingback: Body Memories – Why Child Sex Abuse Never Ends (letters from survivors and non survivors) | INVISIBLE CHILDREN

  11. Carol, thanks so much for writing this letter. As a sexual assault survivor (and health care provider) I have been dealing with these feelings for decades. It is difficult to even talk with my family about it. I hope your message gets spread far enough for all health care professionals to begin the conversation that needs to take place in order for survivors to begin to heal and be taken seriously.

    Liked by 2 people

    • Thank you for your feedback and for sharing your experience. Communication is very difficult for many survivors including myself. Since I too know the struggle, I wanted to write something that would give voice to what many of us experience and could possibly be used as that conversation starter for those who may not be able to find the words themselves yet. I hope that the letter will influence health care professionals and also be a tool for survivors to communicate their needs to their physicians. Thank you so much again for your comment!

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  12. This was beautifully written. These are all the reasons why I do not see a doctor, except for emergencies. And then I am filled with anxiety and fear. Thank you for putting it into words.

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    • I am the same way so I completely understand. Three years of therapy and the fear and avoidance of doctor visits still hasn’t been beaten, because of how survivors are often treated. That is why I knew this needed to be written. It was challenging, but worth it if it helps even a handful of practitioners better themselves and their treatment of survivors. Thank you for letting me know how you feel about the piece, I appreciate your feedback.

      Liked by 1 person

      • This helped my husband to have a deeper understanding of why I have so much fear and anxiety over seeing a doctor. I think many of us go through life paralyzed in many situations not even knowing why ourselves. I certainly have done this for years because it is too painful and shameful to talk about. And for so long I didn’t even understand myself what was happening to me or why so I just avoid these situations. So thank you, this was so very important!

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  13. Hi, just want to kindly point out… I think on the 9th paragraph – starting with “I can’t even begin to… ” – it is missing the word “talking”

    > “To be honest, talking about it..”

    (Also thanks for the read. :))

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  14. Reblogged this on Out of the Rabbit Hole and commented:
    This is a fabulous post. I hope that this will help spread the word about being trauma informed. Although it talks mostly about sexual abuse, the physical abuse can be revisited in the doctor’s office with even the simple act of holding one down on a table to do an exam. Or holding their head to look into the mouth. I am going to let this blog speak for itself, I will revisit this.

    Liked by 1 person

  15. Carol, thank you. Thank you for your courage, for the time you took in creating this beautiful call-out. I have already shared this widely, it’s potential impact is infinite. An incredibly important awareness that cannot be heard enough. Again, thank you.

    Liked by 1 person

    • Thank you for sharing with me how you feel about the piece and sharing your support in getting it’s message out into the world. I hope that it reaches those who need it most and appreciate you helping it to do so.

      Like

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