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The physical and emotional harm that comes from being abused by a loved one can have unexpected effects for survivors, even after the violence has stopped. If you’ve survived domestic or sexual violence as a child or adult, some everyday activities that used to be easy may now suddenly be difficult.
If you find yourself avoiding visiting the nurse, doctor, or dentist, maybe without even knowing why, you’re not alone. Many survivors of abuse find that seeing a healthcare provider can be anxiety producing. At the same time, taking care of yourself can be a reaffirming experience that helps you move beyond the physical and psychological trauma.
Health care can also be hard because health care environments are not always trauma-informed and there are often time restrictions that limit your ability to connect with your provider. There are steps you can take to make medical visits easier and help you become more involved in your own healthcare. But first, let’s look briefly at some of the impacts of abuse and why they might make going to medical appointments so challenging.
Why is going to my doctor or nurse so hard for me?
Beyond the obvious physical effects of violence like injuries, some of the long-term after-effects of abuse can be subtle but significant. Studies have shown that exposure to trauma and violence can lead to many health problems. The constant stress of experiencing or anticipating emotional or physical abuse takes a toll on the body and a person’s well-being, and can lead to chronic medical issues.
Having a loved one be violent towards you may also be psychologically traumatic. We use a variety of coping strategies to survive the emotional pain: we distance ourselves, minimize the experience or situation, avoid thinking about it, and even sometimes deny to ourselves that what we are experiencing is painful. These ways of coping sometimes make survival possible. However, they can also become a routine way of thinking, or handling difficult situations, when we no longer need them.
Seeing a doctor or nurse means you’re paying attention to what’s going on in your body. At the same time, it might be hard for you to focus on your body for a number of reasons. For example, if you cope by distancing yourself, or “going away in your head”—what some call dissociating—it can make it hard to feel what’s going on in your body. Dissociation is a clever tool our minds have of giving us a break from traumatic experiences and allowing us to function. The problem comes when we no longer need to dissociate, but instead be mentally present and understand any harm we’ve experienced.
To complicate things even more, health care settings like waiting rooms can be stressful and hectic and some procedures can leave us feeling vulnerable or remind us of the violence that we’ve survived. Additionally, language or other cultural differences between you and your provider may complicate your ability to communicate or connect with them which can be stressful. At those times, even though we may not be in danger, it can feel like we are and we might feel upset or afraid, or we may fall back on the coping strategies that helped us to survive the abuse. Those dynamics along with other power imbalances we may experience in our encounters with medical professionals, sometimes make it hard for us to fully participate in our health care.
What can I do to make my nurse/doctor visits easier?
Tell them about the abuse
The abuse you experienced may be affecting your health in some way. If you feel comfortable with your provider, just as you would tell them about your medical history, also let them know that you are a survivor of violence. Explain how you think the violence has affected your health. Discuss any untreated injuries, un-prescribed medications, possible exposure to sexually transmitted infections (STIs), unplanned pregnancies and ways in which you might have coped through drugs or alcohol. Your health care provider can then help you consider ways to address these concerns.
Trust your instincts during this discussion. If you feel scolded or in other ways judged by the nurse or doctor, they may not be the health care professional for you. Looking honestly at your medical issues may be difficult. The relationship between you and your health care provider should have open and caring lines of communication in order for you to feel comfortable being honest with them and relying on their help.
Take charge of the visit
If you’re worried that you might “space out” or dissociate during your visit, make a plan with your health care provider for how you can feel more in control of exams and other visits so that you can remain aware and participate in decisions.
If you are unsure what to ask for, consider this trauma-informed healthcare approach you can share with your provider:
1. The healthcare provider and fully dressed patient meet before the physical exam to discuss the reason for the visit and to review the procedure step-by-step.
2. The provider leaves and the patient changes for the physical exam.
3. During the exam, the provider waits for the patient’s approval before every step. For example, the doctor might say, “Now I’m going to lift your gown and push hard on your abdomen, OK?” The patient indicates whether or not the provider is OK to proceed. If the exam can’t be completed, the provider and patient agree to reschedule it and discuss ways in which the procedure might be made easier, if possible.
4. After the exam is completed, the patient has the option of getting dressed again before discussing possible next steps with the doctor.
5. To the extent possible, the provider leaves the patient with written follow-up information, diagnoses, and next steps.
Change these steps if needed so that they feel most comfortable for you.
Ask someone to come with you
At times, it may be helpful to have a friend go with you to your appointment—if you are having a hard time getting yourself to go for medical exams, or if you are afraid you will not remember your discussion. Your friend can sit in the exam room with you just for support, hold your hand during painful procedures, or be the designated note taker so you can remember and review the details of the appointment later. It is important to note that many health care providers will want to meet with you alone during some part of the exam. At this point you can ask your friend or support to step outside but let the provider know that during the exam you would like your friend present.
After your medical appointment
Take some time after your appointment to reflect on how it went. Write in a journal on your own or sit with your friend or support and discuss your appointment. Consider how it felt and what you learned. Did you feel comfortable with your health care provider’s approach? Do you understand the results of your visit and your next steps? Do you feel your provider listened to you and took the time to help you understand your options? This time and thought can help you relax, plan and stay on track when it comes to caring for yourself.
These free confidential hotlines are available 24 hours a day with access to language interpreters. Some of the websites offer hosted chats:
National Domestic Violence Hotline 800-799-SAFE (800-799-7233) www.thehotline.org
National Dating Abuse Helpline 866-331-9474 www.loveisrespect.org
National Sexual Assault Helpline 800-656-HOPE (800-656-4673) www.rainn.org
Childhelp National Child Abuse Hotline 1-800-4-A-CHILD (1-800-422-4453)
National Suicide Prevention Lifeline '1-800-273-TALK (1-800-273-8255)
A few weeks ago I described some of the ways that people helped me talk about what had happened to me as a child and by talking about it, begin the healing process. These people weren’t clinicians, they just wanted to help me: people like my husband, friends and co-workers.
As I mentioned in part one I’m hoping you will think about these ideas, share them with the person in your life who has survived violence and ask him or her what might you do to help. Consider this a starting point to your discussion-–not an ending point.Keep Reading »
April is Sexual Assault Awareness Month and Child Abuse Prevention Month. I am reposting this for those who know someone who has been abused. This is how you can help.
We all know -- and many of us are close to -- people who have survived sexual abuse or rape. Chances are, many of you reading this are survivors yourself. We often encourage survivors to speak about their experiences, to get it out. It's cathartic, it helps us to move through the pain, it helps us see that we're not alone and that it wasn't our fault.
We might not think as much about how to be on the receiving end of the story. What should we say? How do we talk with a survivor in a way that helps her heal a little bit more and feel okay about having told someone?
Here are some of the most important things that my friends and family have done that really helped me. I'm hoping you will think about these ideas, share them with the person in your life who has survived violence and ask him or her what might you do to help. Consider this a starting point to your discussion--not an ending point.
Listening sounds like a pretty easy thing to do. We do it every day, right? I used to think I was a good listener but I know now I was an okay listener. When friends talked to me I couldn't escape my thoughts. Rather than focusing on what they were saying, what I was sensing from them or what they might need from me, I focused on what I was going to say. Oftentimes, I interrupted them to say it.
The things I said often weren't even for their benefit. For example, if I heard something that made me uncomfortable or even triggered me, I wanted to reassure them and end the conversation. So I would say, "Well, I wouldn't worry about that" or, "That's no big deal." But they were worrying about it and it was a big deal to them. In my effort to reassure, I didn't listen at all. I dismissed their concerns.
I still do this, but a lot less often. I know the difference between really listening to someone and just kind of listening but mostly focusing on my feelings. Now, I try--admittedly not always successfully--but I try to really listen. I started learning how to do this in therapy when I noticed that the psychiatrist with whom I worked listened so well. On the rare occasions when his listening skills weren't their sharpest I noticed how different my time with him felt.
I learned about listening in a more profound way from my partner. I experienced through her what it felt like to have someone you care about really hear you. It's an amazing feeling to not be brushed away. I know she works at being a good listener, but she is also a keen observer. She can sit and listen and doesn't seem to be anywhere else than with the person to whom she's talking. She doesn't typically go to her fear to respond or need to end the conversation. She can tolerate the pain the person is in to be in it with them, without being pulled into it.
By watching and talking with her I have become a better listener. Not as good as I want to be, but I keep trying. As I get better, people seem to feel more comfortable sharing their thoughts with me. People talk about their anxiety, fear, and despair and I am better able to wash away my fears, my anxiety, and my uncertainty to focus on them. I have found that when we listen intently without a need to do something about what we're hearing, people will share more with us.
When we ask survivors to speak out against their abuse, we have to know how to listen, really listen.
When memories of abuse first started returning to me, I decided to tell a friend who I had known since I was 13. I was terrified that she wouldn't believe me. As a young teenager, I had found refuge in her home and family, and she had known my family well. She was shocked to hear what had happened, but believed me. She said, "Now things make more sense to me. I thought there was something weird with your family." I was so relieved. Her response helped me to continue to talk to her about my memories and gave me the confidence to tell other friends.
Even around having Dissociative Identity Disorder (DID) I needed to know that if I told someone they would believe me and know I am still the person they have known for years just with more information about myself. There are still people I meet today that say "I don't believe in DID". It feels very sad to hear that. Its not a religion.
I was lucky enough that everyone else I told then believed me: my psychiatrist, my husband, my other friends and coworkers. This seemingly simple response of believing a survivor is powerful. My father told me for years that no one would ever believe me. Even if they did, they would understand only that it was my fault. My father had so much power over me I believed him. My family acted as though nothing was happening to me, and I saw no reason to think that anyone else would act differently. Being believed over and over by those close to me as an adult helped me to eventually accept what had happened to me and start to heal.
To be continued ...
Keep Reading »
Now after many years of healing I am happy, and not just on the surface. Despite how difficult it can still be to grieve and remember all I have been through, I am proud to say that I am better than I have ever been. I feel more stable. I believe this is because I am more whole than I ever have been. I have learned about the ups and downs of the process and survived them year after year. I have a wonderful relationship with a partner and am blessed with great friends.
Still I struggle (see the bumpy road of healing). The holidays are especially painful, as are anniversary dates of particularly brutal or repeated attacks. Some years are easier than others. This year the release of my memoir, The Sum of My Parts: A Survivor's Story of Dissociative Identity Disorder, threw me an unexpected twist. Even though I felt a sense of pride and accomplishment in writing the book, I had no idea how exposed I would feel when it was released.
Nowadays, when things get hard, I remind myself that I have lived through this before: the depression, the suicidal thoughts, the deep despair. I know from my experience of healing that as bad as I might feel, I have come out of similarly painful times and I will get through this one, too.
I have worked hard to balance the dark thoughts and self-doubt with positive thoughts of all I have and who I have become. I remind myself how lucky I am to have survived and thrived despite all the violence I endured. I remind myself that I am strong and resilient.
Each time I come out of the darkness I revel once again in the light and my newfound strength. I have overcome it and when it comes again, I will ride that out, too. In the meantime, I enjoy the peace of feeling happy, sane and stable. I enjoy as much of my life as I can: rejoice in my partner, our dogs, our friends. I laugh hard, sleep well and work hard.
For all of you who struggle with memories of child sexual abuse, sexual violence, or dissociative identity disorder - it does get better, even when you think it can't.
In Latino culture you aren’t supposed to talk about your problems. You aren’t supposed to think about yourself if you are a woman. You are supposed to think about your family and care for them. Discussions around consensual sex are not engaged in very easily.
So what happens when you bring a group of women together who are originally from all over Central and South America to talk about sexual assault, child sexual abuse, trauma and DID?
Well, its an interesting conversation with all sorts of indirect communication through body language, people thanking you for coming in the hopes that they can shut down the discussion, when in fact you are in the middle of your discussion. Generational divides happen. Class divides become more obvious. A frank discussion about rape, abuse, trauma, DID and sex after violence happens. In this room, we did what some were afraid to do and we did it because one woman wanted to know and I wanted to answer as if it were a normal thing to talk about.
At one point several of us had a discussion about the word for disorder in Spanish. Does it even mean what we use it for in English? Most of the women in the room took their cues from me. If I was comfortable talking about it they would try. So we went all day talking about all sorts of taboo topics. And finally at the end, several of the women talked about their own experiences as victims of child sexual abuse and rape, depression and in the discussion we cried, and wondered how we would all talk about this again, with Latinas. Their solution, a book club, where they would choose books that helped them discuss the realities of their lives.
It was magical and sad. In my community I am very different and I want to show others the way.
Keep Reading »
I've been healing from the trauma of Child Sexual Abuse for years off and on. My work both personally and professionally has been to help others understand the impact of trauma and more recently to help people understand Dissociative Identity Disorder. My belief in my stregnth has been steadfast but recently I gave in to the pain of the past and took steps that could have killed me, but for the intervention of my partner.
Its been an incredibly difficult experience and a very humbling one. With the work I have done around the country, in writing my book and now blogging for Psychology Today, I thought I was above the pain. I became complacent - thinking I'd never do anything to hurt myself. I didn't pay attention to the power of this pain and the memory of the past. So as my book comes out this fall. As happy a life as I have built for myself there are still painful memories that can take over - I am far from perfect, and will continue to struggle.Keep Reading »
My upcoming memoir, The Sum of My Parts: A Survivor’s Story of Dissociative Identity Disorder, emphasizes the healing process and the nature of resilience. These installments from Chapter One contain some descriptions of violence only for the purposes of illustrating why and how dissociative identity disorder is formed. Please take care in reading these installments.Keep Reading »
We all know and many of us are close to people who have survived child sexual abuse or rape. Chances are, many of you reading this are survivors yourself. We often encourage survivors to speak about their experiences, to get it out. It’s cathartic, it helps us to move through the pain, it helps us see that we’re not alone and that it wasn’t our fault.
We might not think as much about how to be on the receiving end of the story. What should we say? How do we talk with a survivor in a way that helps him or her heal a little bit more and feel okay about having told someone?Keep Reading »
The more I think about it, the more I marvel at the skill of the psychiatrist who helped me heal from Dissociative Identity Disorder. As I look back on our work together, I can spot a number of creative strategies that he used.
Let’s call him Dr. Summer.
I don’t know whether Dr. Summer drew upon his experience working with other survivors of abuse or spontaneously invented some tools in his work with me. Some of these techniques must have been specific to my circumstances, and should be understood in that context before adapted to others. Here are the tools I found most helpful.
Keep Reading »
In order for me to learn how to stop dissociating, I first had to figure out when I was doing it. I had to recognize how it felt and learn to see the difference in how I felt when I wasn’t dissociating.
My psychiatrist gently guided me through this process. He often stopped me whenever he saw that spaced-out look on my face. “How do you feel?” he would ask. I described to him the numbness and fog that had overtaken my thinking, a sensation like having cotton in my head. “That’s what dissociation feels like. Try and remember that feeling,” he instructed me. After several months of stopping and noticing, I eventually got the distinction. It’s like the difference between looking at life from 50 feet up versus living life at ground level, with all its vivid emotions and bumpy reality.
Keep Reading »
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