In the era of #MeToo, Missy Elliot, Whitney Houston, Tyler Perry, Oprah, Ashley Judd, Gabrielle Union, Teri Hatcher and, now, Padma Lakshmi — keeping kids safe and helping adults heal is our job as physicians. I am a pediatrician — and I am an incest survivor. My perpetrator was also a physician. I bore a dirty secret before I knew what a secret was. The person who hurt me was the person I trusted the most. Nothing made sense, yet I talked to no one about it for the first two decades of my life and didn’t seek help until my third decade.
Incest is gross.
Incest continues if you ignore it.
People sit in pain if they are not allowed to heal from the repercussions of it.
Incest is not an isolated occurrence. Many things have to align for it to occur; an orchestra of family dysfunction and bad behavior; further heightened by the twisting of many arms and the telling of many elaborate lies to perpetuate this increasingly evolved orchestra. Demands trump logic, lies dominate safety and a perverse contortion becomes the permanent family stance taken in order to save face, most importantly, of the perpetrator.
Incest survivors are smart. We are wonderful negotiators, fiercely protective and always innately aware of our environment. We are also taught before we can speak that our role is to accommodate the needs of others. Survivors will loyally protect others often at the detriment of ourselves — until we no longer can. Until we hurt ourselves, hurt others or cross our perpetrators and get help.
Who creates this environment? Like any powerful event, it is not done in isolation — it is the work of many adults and many generations. Deep, thick roots, dug deep in the ground with no intention of budging. A mother “unknowingly” grooms a daughter for her father or lets him sleep alone in the same bed as her though he is known to have molested other kids.
Family members pretend they never heard that ever happened since he is the uncle that throws the big parties or owns the family business. Mom negotiates with her daughters to let stepdad back in the house because he didn’t really do much more than touch her daughter’s bottom and he’s their sole source of income. Or the five-year-old is making things up because that’s what they do at this age according to the policeman. We all create this environment — until we don’t. Every time we look away, we quiet a voice because of our personal discomfort we support the environment that fosters incest. So get used to the word. It’s not a bad word. The action is bad, the person who perpetrates on an innocent child should be the one dealing with the consequence.
Please allow the survivor to say: “I am an incest survivor and I have PTSD” so that they can explain body memories and explain medications, explain the inexplicable acute manifestation of an inflammatory disease. Or so they can explain that they are not stupid or forgetful but, in fact, learned to disassociate as a child to protect themselves in unsafe environments. Or so that I can explain that I am not crazy or unstable, but am falsely wired to worry a lot and frequently and it takes the world to calm myself. Allow survivors to say that so they can continue to fiercely resist and/or recover from addiction to sex, love, cigarettes, food, alcohol, prescription medications, picking skin, soda — you name it. And say it so we can continue to work as hard as I have been working to heal, but not in deep secret, as I had to as a kid to keep someone’s secret that hurt me.
Society unknowingly retraumatizes victims of incest when they turn their head the other way. The burden is released when you accept the word “incest” and remember that the action, not the word, is demonic. Physicians play a critical role. They can unknowingly retraumatize an incest survivor, or they can be the key to unlock the door, releasing someone from their internal hell. Over time, I have learned how to turn the key. Here is my experience, strength, and hope as a physician who has survived incest and continues to work with children and families that experience it:
1. Ask the question. Don’t be scared. Only good will come of it. Someone, be it a child or adult, will only tell you when they are ready too. If they tell you, it is because they need the help and they trust you.
2. Have a high index of suspicion. If the story doesn’t add up and something in your gut suspects child abuse, speak to the patient alone, speak from a place of safety and compassion. Inform them, before asking, that you are a mandated reporter (otherwise it can devastate that fragile trust you built).
3. Listen. Don’t bring in another person’s story. Minimize interruption. Echo back condolence, sadness and thank them for being brave and trusting to tell you.
4. Assess for imminent threats. Do they live with the perpetrator, can they return home, are they suicidal?
5. Do not touch/hug as a sign of empathy. These are natural human instincts but can feel very different to a victim of incest or child abuse.
6. Help a patient come back to the present with grounding exercises like deep breathing, stating their full name, date, and location.
7. Know the laws around mandated reporting. When in doubt call and run your case by Child Protective Services.
8. Debrief with a trusted colleague (respecting HIPAA), ground yourself before moving on to the next patient.