CarolLChandler

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

42 comments

  1. Thank you very much for having taken the time to write this letter and make it public. I hope that it will reach the heart of all medical workers who have the choice and power to improve all sexual abuse victims.

    Carole 💜

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  2. I got sexually assaulted by this doctor urologist and the hospital decided to side with him. He knew what he did too. I’m sadden and hurt. 😞 but your letter sure helped me thanks for it. I’d love to talk to someone about who’s been in the same situation.

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  3. This is so spot on. I can relate on so many levels.I almost want to copy this and hand it to my physicians. I have neglected to go to any drs because of all the reasons mentioned
    I felt so validated reading this
    Thank you

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  4. Carol,

    Thank you for your letter. I am in the same situation, but under different circumstances. I was abused by doctors and nurses at the age of 5. I avoided healthcare all my life, but when I trusted a PCP, I was physically abused by a nurse which only validated my phobia and left me with PTSD.

    Read my story here: http://madmanbanterings.blogspot.com/2021/01/my-friends-story-of-abuse-by-healthcare.html

    The only reason that I am not totally opting out of healthcare all together is because my best friend wants me to take better care of myself. She supports and encourages me, no shaming or bullying. I am in therapy now.

    I also met an amazing person that I have become friends with who is a patient advocate; Archie Banterings. (He is on Twitter and Blogspot.) He has shown me how to take control of healthcare encounters using the Americans with Disabilities Act (ADA).

    You can read about how I use the ADA in my story linked above to Archie’s blog.

    It is hard when your abuse was by healthcare providers, the intent was not malicious (my psychological wellbeing was neglected). I am only doing this because of my best friend. If anyone would try to tell me to do this for myself, I would tell myself to simply avoid healthcare. I have to do this for someone that I care about or I wouldn’t be doing it.

    I have found that under the hurt and fear is anger. I can let go of anger in ALL other aspects of my life except for healthcare. When I try to let it go, the hurt and fear convince me that I need it to keep me safe. It is a vicious cycle.

    I very much can relate to your letter, your feelings, and the core of my trauma coming from the loss of control over my bodily integrity. My coping mechanism is to be in total control of the encounter.

    Thank you. Your courage gives me hope.

    ~✿~✿ Melissa ✿~✿~

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  5. Carol,

    Thank you for this powerful piece.

    I am affiliated with a medical school offering a lecture on this topic, and would look forward to speaking with you to hear your perspective.

    If you are interested, please email me at cc4370@cumc.columbia.edu.

    Best,
    Caroline Cherston

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  6. Thanks you so much sharing information.I also have some problems with my ear and throat and was showing to an ent doctor long island
     and I do accept as true with that you have to show yourself to a particular expert for you trouble, in preference to displaying to a ordinary clinical medical doctor.

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  8. I hear you. A good experience I had: I was having my coil changed, and had been far too anxious to have it done without sedation (the doctor literally “couldn’t get in there”.

    Trigger warning: rape
    A month later, at the Gyno clinic, I waited for a few hours for my turn. I hadn’t been able to sleep the night before, and my anxiety was ratcheting up by the minute. The thought of being unconscious, exposed, with a (male) doctor doing painful things to my bits, and with a bunch of people standing around watching (anaesthetist, etc) was horrifying. (My most recent trauma was being drugged and raped, so the general anaesthesia was freaking me out a lot. I had no idea that I would react this way beforehand!) No matter how much I reasoned with myself that this was different, I’d asked for this, and there was no chance of abuse with so many people around, it made no difference.

    When I was on the verge of grabbing my stuff and making a run for it, a nurse asked if I was OK. I told her that I was having severe anxiety. She took the time to find out why. When I managed to squeak out that I’d been raped a few years before, she was wonderful. She asked me what I needed and made some suggestions. She asked the doctor to come and meet me so I knew who was doing the procedure. She held my hand on the way to the operating room. She had asked all the male staff to leave the room until I was under, and said that I didn’t have to put my feet in the stirrups – I could lie flat, covered up, and they would move me once I was unconscious. She held my hand throughout, and was there when I woke up afterward.

    Her understanding and support, and the willingness of the whole team to make a few small alterations to their routine in order to make me more comfortable, was… Amazing, especially since they were extremely busy.

    Just before I left, I thanked her and asked if she’d had special training. She basically said, “Not official training, but this is the Gynecology Service. You wouldn’t believe how many traumatised women we see. We all learn quickly.” I do believe it. And I’m so thankful that they took the time to learn what we need.

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  9. This is so well said. This is where I am now. I wasn’t taken seriously by my local obgyn. I was forced to get a procedure done I didn’t want because I heard they failed. I had had already 3 D&C that did nothing for me so I hid the severe pain and bleeding until my blood counts were down to nothing. I didn’t know at the time I had advanced endometriosis. During my ablation procedure I stopped breathing. She never told me. I found out when I ended up septic admitted in the hospital more than 3 weeks later from a doctor I never met. That local obgyn can’t to my bedside and told me “I was so adamant at wanting a hysterectomy that I was bellyaching to have one”. Not one doctor at my Er would examine me. She labelled me as mentally ill from past trauma. I was sexually abused as a child by a family member and not believed when I was told. It happened again in a foster home then it happened a third time when my family doctor sent me for inpatient PTSD counselling. He met me there to do my intake. He had been trying really hard to get me in for a physical and I refused. He got his secretary to call me in urgently then he screamed at me belittling me then sent me to the psych ward on a 72 hours hold brought there by police. He got me sedated and assaulted me. I couldn’t move I saw heard and felt everything. A few days later I confronted him. He had me super drugged up and tried to get my mom to sign me as ward of state so he could send me to a mental institution for the rest of my life. My no refused came to the hospital and told me to spit out the pills I did and returned home. After that I refused to ever go see him again. I never spoke about this until now. Not one doctor took me serious. I was literally begging for a pelvic exam as much as they really screw me up. My new family doctor was also poisoned by what she wrote in my file and also sent me to the psych ward by police again. I went and picked up my imaging and my medical records at my local hospital and as soon as I got out of my vehicle my heart raced. I vomited multiple times in the parking lot. I had to sit and cry because I struggled to take a breath. People gathered and I wanted them to go away. I couldn’t speak trying to ground myself and not disassociate. I pulled my cellphone out and wrote PTSD a lady told everyone to go away. She assisted me in getting what I needed. She told me her name but I don’t remember. I wish I did. Now I need to travel 10 hours and trust another doctor to perform serious surgery. During my endometrial ablation my endometriosis what ver advanced and she burnt my bowel so September 7th full hysterectomy bladder repair possible small bowel resection or worst case colostomy. The surgeon took me serious after I wrote her a letter regarding my sexual assault by a doctor. I’m a little more comfortable with her but still scared out of my mind. It’s not the surgery. I watched it online. It’s the anesthesia and the pain control. If I’m high on pain meds I’m going to freak. That’s why I don’t drink don’t smoke and don’t do drugs. Pain managing in this has been very hard. It’s going to be a challenge coming out of this. I’ve done everything to try to get out of this. I’ve beaten myself for being weak and not able to function in this. I’ve had chronic pain from my autoimmune diseases my entire life and i have a very high pain tolerance. I walked in a broken ankle for 3 weeks at 9 years old. I suffered beatings and was threatened more harm if I told. Now I’ve got years of putting myself back together. I plan on going after this local obgyn for purposely delaying my care by her mental health bias.

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  10. Hi. Do you know where I would post or how I would find others who were sexually abused by a New York doctor who sexually abused me as kid? ( many years ago ) I know there were others…thanks.

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  15. 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

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      • 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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      • Carol,

        Thank you for this powerful piece.

        I am affiliated with a medical school offering a lecture on this topic, and would look forward to speaking with you to hear your perspective.

        If you are interested, please email me at cc4370@cumc.columbia.edu.

        Best,
        Caroline Cherston

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  21. 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

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    • 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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  22. 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.

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    • Yes I would be honored if you use me letter and I apologize for the late reply, the comments here appear to show up delayed.

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  26. 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.

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    • 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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  27. 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.

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      • 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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  29. 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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  30. 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.

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  31. 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.

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    • 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.

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