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THE HEALTH SYSTEM: RETRAUMATIZING THE VICTIM
By Ann Jennings, Ph.D.
Editor’s note: Stigma can take many forms. When diagnosis and treatment themselves are stigmatizing, the consequences are devastating. In the case of Ann Jennings daughter, the outcome was tragic.
My daughter Anna was a victim of early childhood sexual trauma. She was never able to find treatment in the mental health system. From the age of 13 to her recent death at the age of 32, she was viewed and treated by that system as “severely and chronically mentally ill.” A review of 17 years of mental heath records reveals her described in terms of diagnosis, medications, “symptoms,” behaviors, and treatment approaches. She was consistently termed “non-compliant” or “treatment resistant.” Although it was initially recorded, her childhood history was dropped from her later records. Her own insights into her condition were not noted.
When she was 22 Anna was re-evaluated after a suicide attempt. For a brief period, she was re-diagnosed as suffering from acute depression and a form of post-traumatic stress disorder. This is the only time in her mental health career that Anna agreed with her diagnosis. She understood herself, not as a person with a “brain disease,” but as a person who was profoundly hurt and traumatized by the “awful things” that had happened to her, including sexual torture by a male babysitter.
For nearly 12 years Anna was institutionalized in psychiatric hospitals. When in the community, she rotated in and out of acute psychiatric wards, psychiatric emergency rooms, crisis residential programs and locked mental facilities. Principal diagnosis found in her charts included: borderline personality with paranoid and schizotypal features, paranoia, undersocialized, conduct disorder aggressive type, and various types of schizophrenia including paranoid, undifferentiated, hebephrenic (disorganized schizophrenia), and residual. Paranoid schizophrenia was her most common diagnosis. Symptoms of anorexia, bulimia and obsessive compulsive disorder were also recorded. Treatments included family therapy, vitamin and nutritional therapy, insulin and electroconvulsive “therapy,” psychotherapy, behavioral therapy, art, music and dance therapies, psycho-social rehabilitation, intensive case management, group therapy, and every conceivable psycho-pharmaceutical approach. Ninety-five percent of the treatment approach to her was the use of psychotropic drugs. Though early on there were references to dissociation, her records contain no information about or attempts to elicit the existence of a history of early childhood trauma. Survivors of trauma tell us the capacity to think and to feel is essential for recovery. Psychotropic drugs continually robbed Anna of these capacities.
Medication can be helpful if used cautiously, with the patient’s full understanding and consent. But without knowledge of which medications can alleviate symptoms and facilitate recovery from trauma, medications can cause incalculable damage. For Anna, psycho-pharmaceutical treatment was a metaphor for her original trauma. As sexual assault had violated physical and psychological boundaries of self, forced neuroleptic drugs intruded past her boundaries, invading, altering and disabling her mind, body, and emotions. She once said “I don’t have a safe place inside myself.”
Anna was 22 when she learned through conversation with other patients who had also been sexually assaulted as children, that she wasn’t “the only one in the world.” It was then that she was first able to describe to me the details of her abuse. This time, with the awareness gained over the years, I was able to hear her.
The reaction of the mental health system was to ignore this information. When I or Anna would attempt to raise the subject, a look would come into the professional’s eyes, as if shades were being drawn. If notes were taken, the pencil would stop moving. We were pushing on a dead button. This remained the case until Anna took her life, 10 years and 15 mental hospitals later.
The tragedy of Anna’s life is daily replicated in the lives of many individuals viewed as “chronically ill.” Their disclosures of sexual abuse are discredited or ignored. As during early childhood, victims learn within the mental health system to keep silent. A wall of silence isolates childhood sexual abuse from the consciousness of the public mental health system. No place exists within the system’s information management structures to receive this data from clients.
Resistance to the sexual abuse trauma model has been resisted for 130 years, during which the original role of sexual abuse violation in mental illness has been alternately rejected and denied. Each exposure was met by the scientific community with distaste, rejection or discredit. Each revelation was countered with arguments that blamed the victims and protected the perpetrators. Today, despite countless instances of documented abuse, this tradition of denial and victim-blame continues to thrive.
Although the forces of truth will continue to meet resistance, they appear to be forming a powerful movement that will promote acceptance of a trauma-based model recognizing the pain of individuals like my daughter, and offering them what Roland Summit calls “the radical prospect of recovery.”
You can read more from Anna's mothers view here: http://www.power2u.org/articles/trauma/annas_story.html