cont. from

Self-fulfilling prophecy

The effect of institutional retraumatization was to leave Anna "in a condition that fulfilled the prophecy of her pathology." (S. Stefan, unpublished manuscript, "The Protection Racket: violence against women," University of Miami, 1993). This was especially true in the use of psychotropic medication. Survivors of trauma tell us the capacity to think and to feel fully 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 to me, "I don't have a safe place inside myself."

Denial

Although the established paradigm may help alleviate the suffering of those whose mental illness is strictly genetic or biological, it is failing for a significant group whose histories contain sexual and/or physical trauma. This group may be as high as 50 to 70 percent of women hospitalized for psychiatric reasons, according to J. Briere and M. Runtz in New Directions for Mental Health Services 1991). But a new paradigm, based on trauma, is emerging.

Paradigm shifts are always initially resisted. They disrupt the status quo, create tension and uncertainty, and involve more work. Resistance to a sexual abuse trauma paradigm has existed for over 130 years, during which the etiological role of childhood sexual violation in mental illness has been alternately discovered 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.

Psychiatrist Roland Summit refers to this denial as "nescience," in Psychiatric Clinics of North America (1989). He proposes that "in our historic failure to grasp the importance of sexual abuse and our reluctance to embrace it now, we might acknowledge that we are not naively innocent. We seem to be willfully ignorant, "nescient."

An emerging paradigm

The cost of such nescience is high in material as well as human terms. Anna's hospitalizations alone totaled $2,718,720. But now, multiple and divergent forces are confronting nescience with truth. These forces include: the victims themselves, speaking out for the first time a growing body of research based on a trauma paradigm political support for this paradigm as legislation turns its attention to women's issues new therapeutic approaches to sexual trauma formation of new professional associations based on the experience of trauma legal attention to the treatment of women in psychiatric institutions the advent of health care reform, which seeks to find more cost-effective, less restrictive treatment Although the forces of truth will continue to meet resistance, they appear to be forming a powerful movement that will help to protect children from adult violation and will promote acceptance of a trauma-based paradigm recognizing the pain of individuals like my daughter, and offering them what Roland Summit calls "the radical prospect of recovery."

The table that follows illustrates Anna's retraumatization by conventionally accepted psychiatric practices and institutional environments.

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Written Fall 1994. Reviewed: 04/2006