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As a psychiatrist, I’ve spent almost two decades caring for patients who have survived sexual trauma, be it childhood sexual abuse, rape or repeated and threatening forms of sexual harassment.
I’ve witnessed how when the assailant was known to the victim, especially someone from whom they expected comradery or even just professionalism, it can be devastating. The fact that the assailant came from within a trusted circle often delivers the toughest of blows.
The stigma that shrouds sexual trauma means the survivor, who risks being shamed, is often forced into silence. I’ve lost count of the times my patient has kept their sexual trauma a secret reasoning, “I did not think anyone would believe me” or “I figured if I tried to forget about it, it would all go away.” Unfortunately, such silence often proves poisonous, leaving survivors to grapple with the messy emotions of anger, denial, fear, shame and guilt.
When assault survivors do speak up they often face “secondary injuries” ranging from victim blaming to unintentional injuries caused by friends, family, and colleagues who, though they may believe her/him, question their character and worth.
Last Fall, when news cycles filled with sexual harassment scandals from the worlds of Hollywood, media and politics something surreal happened. For the first time that I can recall, conversations about sexual trauma were overflowing well beyond the narrow confines of my clinic room. They were showing up in conversations with friends at dinner, with family members both young and old, social media streams and the table of contents of prestigious medical journals.
When TIME Magazine named the #MeToo movement as their Person of the Year, my colleagues and I were sharing a sense of optimism. Finally, the rest of the world might understand what we had been bearing witness to all this time. If survivors who had a voice, platform and societal advantage were speaking out AND being heard, this could mean a positive trickle-down effect for our patients, most whom did not come from such privilege. Maybe now we would see much needed societal introspection, a cultural shift, organizational changes and stronger laws.
But that was then, in 2017. Today, some say we are in the midst of a #MeToo backlash. This new year has seen stories suggesting #MeToo has been sloppily invoked and public reactions are becoming reflexive. In January, nearly 100 French women activists, academics and actresses signed an open letter stating that the #MeToo movement had gone too far, becoming a "witch hunt" against men.
The recent publication of Babe.net’s story about comedian Aziz Ansari sparked national debates about what constitutes sexual assault, rape and harassment versus flirting, seduction or confusing consensual sexual experiences.
In the public war of words that ensued, I started to fear the #MeToo discourse may become derailed. It dawned on me that a crucial piece has been missing from the public discourse about #MeToo: the hard-earned knowledge of scientists who have, in recent years, been studying sexual harassment in unprecedented depth and scale.
The Veteran's Health Administration (VA) is required to actively screen every single patient for sexual trauma as part of their routine care. In this sense, it is quite unlike any other healthcare system I have ever worked in. Add to this the fact that it is also the nation’s largest healthcare system, serving 9 million veterans per year, and we have a unique (and precious) opportunity: To understand, on a population level, the impact of sexual assault and harassment.
Many lessons have emerged from this new science of sexual harassment. Though it is true the bulk of this research comes from veteran populations, from a clinician point of view, these lessons feel widely applicable.
Lesson 1: Definitions Matter, Precision Matters, Measurement Matters
Definitions matter. It’s vital that when discussing sexual harassment whether it be with a survivor, colleague, friend or relative we are on the same page about what we are referring to.
Ambiguity causes confusion and in the emotionally charged arena of sex and sexual relations, confusion causes chaos.
Defining sexual trauma and then successfully implementing methods for frontline healthcare professionals to screen for it, researchers have been able to measure the magnitude of the problem.
When veterans are asked, by their doctor, if they experienced sexual assault or repeated sexual harassment during their military service, 1 in 4 women and 1 in 100 men respond “yes.”
Both these statistics would confirm the intuitions of many seasoned mental health professionals: sexual assault and harassment are pervasive.
No doubt, survivor anecdotes are powerful but nothing works quite as well as cold hard data to get through to hardened skeptics.
Lesson Two: Sexual Harassment Can Make You Sick
Science now knows much more about the impact of sexual harassment on the human body and psyche.
Research shows how experiencing harassment is associated with higher rates of obesity and chronic pain conditions such as headaches, back pain or fibromyalgia.
Sexual trauma also triggers mental health conditions such as PTSD, eating disorders, clinical depression and substance abuse. In fact, rape is the trauma most likely to lead to PTSD, even more than exposure to war and childhood abuse.
Lesson Three: Big Data Shows Us That Sexual Harassment Can Be Deadly
By mining databases of over six million patients, a team of researchers from the National Center for PTSD unearthed a strong correlation between screening positive for experiencing sexual trauma and subsequent death by suicide. Their data, which was published the American Journal of Preventive Medicine in 2016, showed this correlation persisted even after statistical adjustments were made for age, zip code, medical and psychiatric conditions.
Lesson Four: Harassment Is Bad For the Bottom Line
Researchers collected healthcare data on 426,223 men and 59,611 women. The study results, which were published last September in the Journal of Medical Care, found significant and consistent differences in health care use and costs when comparing those who screened positive for sexual trauma with those who did not. Costs were found to be up to 50 percent higher among those with a positive screen. Moreover, this higher use of healthcare went well beyond care directly related to the original trauma.
While it feels demeaning to think of harassment in economic terms, that may be the shift employers and policymakers need—to feel the impact it has on their bottom line.
The danger of a #MeToo backlash is that it fuels those who seek to deny, doubt, detract and deflect the seriousness of sexual harassment. If movements like #MeToo lose momentum, the spotlight on sexual harassment fades. Those who have power to effect change—employers, influencers, leaders and policymakers—then have permission to put this heavily politicized and messy issue on the backburner. By acknowledging the contribution of scientists who have studied sexual harassment, I hope we can take a step toward preventing this from happening.
