Seven Physical ill health: addressing the serious impacts of sexual violence
-
Sarah Nelson
Abstract
I believe that such changes, along with the rejection of prejudicial, gender-biased assumptions about CSA survivors in healthcare, will make more appropriate and effective the treatments and therapies available to them. It will not be sufficient in itself to carry through, in medical practice, excellent recommendations already available to healthcare professionals for sensitive approaches to abuse survivors: about ensuring that healthcare offers a safe welcoming environment, confidential services, the availability of chaperones, an awareness of ‘triggering’ examinations, and sensitivity in questioning about assault history (for example, Teram et al, 2006; Schachter et al, 2009; McGregor et al, 2009; Nelson, 2012b). Such thoughtful survivor-centredness in routine practice is very important, but it is only part of what is needed. In this chapter I challenge conventional theories of the links between child sexual abuse (CSA) trauma and physical ill health. The chapter explores the extent and possible causes of widespread physical ill health and chronic pain among adult survivors of CSA. This contributes to their suffering and disability throughout life, becoming an additional burden and stigma. Yet their physical health has received far less research attention than their mental health. Tenacious theories of ‘somatisation’ and ‘secondary gain’ explain away these often serious disorders, yet there are flaws in both theories. The greatest problem adult survivors of CSA have found in accessing respectful, appropriate healthcare and support is the assumption that their ill health must be psychosomatic, or even ‘hypochondriacal’, due to their actual or assumed mental health problems.
I argue the case for the little-considered, direct effects of sexual violence through injury, damage and sexually transmitted infections (STIs).
Abstract
I believe that such changes, along with the rejection of prejudicial, gender-biased assumptions about CSA survivors in healthcare, will make more appropriate and effective the treatments and therapies available to them. It will not be sufficient in itself to carry through, in medical practice, excellent recommendations already available to healthcare professionals for sensitive approaches to abuse survivors: about ensuring that healthcare offers a safe welcoming environment, confidential services, the availability of chaperones, an awareness of ‘triggering’ examinations, and sensitivity in questioning about assault history (for example, Teram et al, 2006; Schachter et al, 2009; McGregor et al, 2009; Nelson, 2012b). Such thoughtful survivor-centredness in routine practice is very important, but it is only part of what is needed. In this chapter I challenge conventional theories of the links between child sexual abuse (CSA) trauma and physical ill health. The chapter explores the extent and possible causes of widespread physical ill health and chronic pain among adult survivors of CSA. This contributes to their suffering and disability throughout life, becoming an additional burden and stigma. Yet their physical health has received far less research attention than their mental health. Tenacious theories of ‘somatisation’ and ‘secondary gain’ explain away these often serious disorders, yet there are flaws in both theories. The greatest problem adult survivors of CSA have found in accessing respectful, appropriate healthcare and support is the assumption that their ill health must be psychosomatic, or even ‘hypochondriacal’, due to their actual or assumed mental health problems.
I argue the case for the little-considered, direct effects of sexual violence through injury, damage and sexually transmitted infections (STIs).
Chapters in this book
- Front Matter i
- Contents iii
- Acknowledgements v
- Introduction 1
-
Setting the scene: some barriers to progress
- From rediscovery to suppression? Challenges to reducing CSA 21
- Lies and deception in the backlash 59
-
Children and young people
- Fact, myth and legacy in notorious child abuse cases: Orkney in context 103
- Stigmatised young people: from ‘abuse fodder’ to key allies against abuse and exploitation 133
- Models for ethical, effective child protection 175
- Community prevention of CSA: a model for practice 213
-
Working with adult survivors of sexual abuse
- Physical ill health: addressing the serious impacts of sexual violence 251
- Producing radical change in mental health: implications of the trauma paradigm 287
- Pathways into crime after sexual abuse: the voices of male offenders 319
- Rethinking sex offender programmes for survivor-perpetrators 349
- Conclusion 373
- References 381
- Index 425
- About the authors 441
Chapters in this book
- Front Matter i
- Contents iii
- Acknowledgements v
- Introduction 1
-
Setting the scene: some barriers to progress
- From rediscovery to suppression? Challenges to reducing CSA 21
- Lies and deception in the backlash 59
-
Children and young people
- Fact, myth and legacy in notorious child abuse cases: Orkney in context 103
- Stigmatised young people: from ‘abuse fodder’ to key allies against abuse and exploitation 133
- Models for ethical, effective child protection 175
- Community prevention of CSA: a model for practice 213
-
Working with adult survivors of sexual abuse
- Physical ill health: addressing the serious impacts of sexual violence 251
- Producing radical change in mental health: implications of the trauma paradigm 287
- Pathways into crime after sexual abuse: the voices of male offenders 319
- Rethinking sex offender programmes for survivor-perpetrators 349
- Conclusion 373
- References 381
- Index 425
- About the authors 441
