Recovering from sexual violence is a healthcare issue
Why we need to invest in community-based supports for survivors
Thank you for reading Beyond Survival, a publication about life after trauma. I wrote this piece with the Irish context in mind. I cite Irish statistics and refer to Irish organisations, because that’s the context I understand most deeply. But, the overarching point extends beyond borders and is true no matter where in the world you are.
Imagine waking up one morning to the news that two million people in Ireland had contracted chickenpox overnight. Up and down the country, people were putting wet flannels on their foreheads and trying desperately not to scratch. If two million people were feverish and miserable, you can bet our collective response would be speedy and comprehensive. But that’s not the case for survivors of sexual violence.
According to CSO, two million people in Ireland have experienced some form of sexual violence. 52% of women and 28% of men1 have a visceral understanding of what it means to be violated. Two million of us have worked hard to rebuild our lives, almost always without access to the kind of trauma-informed, specialised healthcare we need.
Sexual violence is understood as a criminal justice issue, but few of us think of it as a public health emergency. The World Health Organisation does. They define it as “a global health problem of epidemic proportions”.2
My personal experience is with child sexual abuse. As a cohort, we are 3 times more likely to develop psychological disorders in adulthood. Depression, anxiety, eating disorders, substance abuse, suicide attempts and PTSD are common. Survivors are also more likely to experience physical health problems including diabetes, gastrointestinal problems, gynaecological problems, stroke and heart disease. One US study put the average lifetime cost per victim of child abuse at $210,012. The harm doesn’t stop with us, but ripples out into our families and communities. Survivors can also pass their trauma to the next generation epigenetically.
Even the harshest jail sentence doesn’t come close to atoning for the enormity of the harm sexual abuse inflicts on a child’s development. Obviously, this is a huge criminal justice issue. But thinking of sexual violence only through that lens allows us to ignore the enormous impact it has on survivor’s overall health and wellbeing.
The vast majority of victims and survivors, including myself, don’t get the support we need to recover.
The people we interact with - police, the legal system, the medical system - are rarely equipped to help us and the society we live in often exacerbates the trauma. In my experience, trying to get help often made things worse.
A few years ago, I had surgery to address a minor issue in my right kidney. I’ll never forget how my doctor swivelled his computer screen around to show me the images from my scan. He pointed to the issue, described how he would fix it in surgery and sent me on my way.
Contrast that with the many years I struggled to get treatment for a mental health disorder caused by serious childhood trauma. Someday I’ll write about how stigmatising, exhausting and expensive (financially, emotionally, in terms of time and mental capacity) it was to first get a diagnosis and then find the kind of treatment I needed to recover. Mental health struggles are different from physical ailments. My diagnostic process relied on me describing my experiences3 and a doctor deciding which label fit me best. Once I got a diagnosis, the treatment plan was six sessions with an eye-wateringly expensive psychologist. I drained my savings to do it, and was severely re-traumatised by the whole experience.4
If I had been diagnosed with cancer, there would have been a network of community support available to me. I’d need doctors of course, but also people to accompany me on the road toward recovery. I’d need lifts to the hospital, advice about wigs and tips for staving off the worst of the nausea. I’d need someone to sit with me as I processed my grief at 3am, and to help me figure out how to access financial support.
When life gets hard, we need people to accompany us. You don’t need a lot of people. A handful of true supporters is enough. But sexual trauma is still a profoundly isolating experience.
When I meet someone who’s been sexually assaulted, there is no community support available. They are directed to therapy and encouraged (often wisely) not to tell anyone. There are many reasons for this, but one of them is money.
Survivors of sexual violence are among the most underserved communities in Ireland.
There are more than 2 million survivors of sexual violence in Ireland.
According to The Irish Cancer Society, about 24,000 people5 are diagnosed with cancer each year.
The Irish Cancer Society’s budget in 2022 was €26.6m.
The Dublin Rape Crisis Centre’s budget in 2022 was €3.3m.
This isn’t a perfect analogy. Other organisations which support survivors of sexual violence get additional funding, and I would never advocate that we should reduce funding for cancer patients. But it is interesting to contrast how much we invest in tackling these two health issues.
The Irish state, together with wider civil society, simply doesn’t spend enough on providing services for survivors.
Sexual trauma changes a person. The person you were before the assault dies, and you have to remake yourself in the aftermath. Nobody should have to do that alone.
Survivors should have access to comprehensive support services, including holistic mental and physical healthcare. These services would be adequately funded, easily accessible in every community, and free from stigma. It is the very least that we deserve.
Thank you for reading. If you enjoyed this essay, you might also appreciate:
💕 If this piece resonated with you, please tap the heart below to help spread the word.
💬 In the comments, I’d love to know how you think about sexual violence. Is it a healthcare issue to you, or how would you define it?
💰If you find value in my work, consider becoming a paid subscriber. For a few quid every month, you can make my career more sustainable.
Unfortunately, there are no Irish figures for those who identify outside the gender binary.
The WHO also unhelpfully frames sexual violence as a ‘violence against women’ issue, which erases the fact that people of all genders both experience and perpetrate sexual violence.
Experiences which doctors later labelled 'symptoms'. To me, it was just my life!
I later requested my medical records, and found that he had made several basic mistakes in my paperwork. He’d misspoken a few times in our conversations too, but it was only when I saw my paperwork that I understood just how careless he had been.
Not including non-invasive cancers, like non-melanoma skin cancers.
Clare, this is a powerful and vital essay to educate people about the issue of sexual violence as a public health concern. I remember reading in Dr. Gabor Mate's book (I think it was The Myth of Normal, but it could have been a different one) about a startling statistic that relates to what you wrote about here: that over 80% of women diagnosed with endometriosis (which I have) were sexually abused/assaulted. That's a phenomenal number, a jarring one.
Also, what's to be said about the correlation between certain autoimmune conditions and cancers and neurological diagnoses with sexual trauma? There's a large percentage there, as well.
In my view, sexual trauma is still stigmatized. Or at least the victims are. We are often silenced, suppressed, and diminished. Even yesterday I met with a friend who told me that her husband "used to push other women sexually" before she had met him. I told her, "That is sexual violence. It's not okay." She didn't want to admit her husband was like that. But I felt it was important to tell her that we need to give voice to the truth, to call things what they are, even when they are ugly truths.
How else will society heal? I don't see another way, besides truth and ongoing compassionate care.
Another thing is, most people don't realize how trauma recovery works. It's an ebb and flow. There are good days and bad days. There is progress and there are seasons of regression. This is all normal. Healing is not linear. But in my experience, few people truly understand - or are equipped - to handle the often volatile swings of recovery. We still don't really grasp mental health, do we?
One reason trauma survivors may never receive the help they need is that the mental health care system is still very much focused on quick, easy solutions. Survivors tend to be overmedicated. If inpatient, their records are like a scarlet letter, an indelible mark against them that can, and often is, used to minimize anything else they may suffer from in the future - medical or otherwise. They are labeled: bipolar, borderline, schizophrenic, depressed, anxious, suicidal.
Professionals in health care do not recognize trauma as the underlying cause of a person's symptoms. They simply treat the symptoms, like a bandage. One example is the granddaughter of a friend of mine, who is 19 years old and is already using a walker. She has severe chronic pain, has seizures daily, suffers from insomnia and nightmares, and is unable to function, let alone work. If you knew her trauma history, you would understand why. Yet the doctors she sees just give her cursory examinations, medicate her, and send her on her way. They do not connect the dots. I see this as one of the many problems with trauma survivors receiving proper care.
Maybe because it's so complex, and the US health care system, anyway, is still designed in a very compartmentalized way: specializations in conventional medicine do not make for comprehensive and long-term care. For those who have access to functional or holistic medicine, it's a step forward. But how many trauma survivors have access to those resources? Not many. Alternative medicine is not covered by US health insurance policies, another problem I see. So, you pay an exorbitant fee out of pocket for alternative treatments, like somatic therapies (EMDR, neurofeedback, brain spotting, myofascial release, psychedelic therapies, etc.). It's grossly unfair.
You are shedding light on an important topic, raising vital questions that must be addressed. The collective trauma of this current society is wrecking humanity. If we don't intervene, what will become of us?
I love your Substack. As a survivor who has struggled with the medical (including mental health) industrial complex all my life, YES. I'm now a yoga/movement teacher and as part of that study somatics and embodiment, including brain spotting and IFS, and WHOA treatment has improved dramatically in the last 3 decades. Somatic and body based psychotherapy actually addresses and can improve the long terms health consequences of complex post traumatic stress. And let me say this...we are all different, of course. I'm not so good with silence. I love your Substack for the way you break with it. And for myself, testifying before US judiciary committees to get the statute of limitations removed for offenders of child sexual abuse, organizing protests, going to the police about my own primary offender gave me a foundation for believing in NOT MY FAULT, which in the end, turns the psyche around. I get this isn't everyone's path. But wanted to speak for its benefits.