Kim Etherington, PhD,
Bristol, UK
Reader in Education (Counselling and Research), University of Bristol
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Re: Response to Hodgson et al.
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This paper raises some very interesting issues that correspond with some of the work I have done with trauma and abuse survivors who present with somatic complaints to their GPs, returning again and again because the underlying issues are not addressed. Doctors sometime refer to these patients as 'heartsinks' - describing the patient in terms that more
properly relate to their own internal responses.
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- "Physicians have been urged to risk asking questions about abuse in the same way that they might ask about other important life events that might affect their patients' health and well-being (Felitti 1998). It may be that clients will initially deny such events (if they are not ready to acknowledge or disclose), but at least they will know that their GP is open to such discussions when and if they should want to talk about it in the future.
"However, the impact on the client of how those disclosures are received can also be crucial - when disclosure is dismissed, denied or disbelieved, clients can feel re-abused and withdraw, perhaps never to risk disclosure again. Some GPs do not recognise the ways that abuse survivors present within the practice. Judith Herman (1992) says:
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- 'All too commonly chronically traumatised people suffer in silence, but if they complain at all, their complaints are not well understood. They may collect a virtual pharmacopoeia of remedies: one for headaches, another for insomnia, another for anxiety, another for depression. None of these tend to work very well, since the underlying issues of trauma are not addressed. As caregivers tire of these chronically unhappy people who do not seem to improve, the temptations to apply pejorative diagnostic labels becomes overwhelming'. (p.119)
"The GPs response can mirror the feelings of helplessness, rage and confusion of the abused 'child' that may be trapped within the adult who has not found a way of telling their story, (Etherington 2000). Some GPs still believe that sexual and physical abuse is not something that occurs on their patch - maybe on the one next door - but certainly not on theirs. A small study undertaken by a counsellor working in general practice showed that this was the belief of the doctors with whom she was working, even whilst she was regularly dealing with these issues a few doors down the corridor in the counselling room (Santi-Ireson 1996). Needless to say, these attitudes and beliefs will not be conducive to enabling clients to disclose and subsequently, heal."
(1) Etherington, K. (2002) 'Physical and Sexual Abuse' in J. Keithley, T. Bond and G. Marsh (eds) Counselling in Primary Care (2nd Edition). Oxford: Oxford University Press: 193-208.
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- "We have been conditioned by society to seek a cure from doctors when we are ill. This is based on a belief in the dominance and wisdom of medicine, a patriarchal institution, rather accepting our own resources as equally valuable or the idea that we know our bodies more intimately than any one else ever can. We tend to listen to medical opinions and diagnoses before asking ourselves 'what is my body telling me about my life and what I need?' Yet many of us are also ambivalent in our attitudes to medicine - sometimes seeking medical help and opinion whilst also rejecting it and feeling dismissed when we are offered unsatisfying solutions to our ills.
"When we listen to the messages carried by our bodies - messages about just how bad we feel - and accept those feelings without judgement, we can free up the energy trapped in denial or in endlessly searching for external cures, and use it to move us towards what we really want (Northrup 1998). By deconstructing or re-interpreting our bodily pain we might be able to name our emotional distress and begin to explore our relationship to it and its meaning; 'what is it that I need to know about myself that my fear (or anger) is trying to tell me through my body?' 'what does this illness gives me that my body knows I need?'"
(2) Etherington, K. (ed) (2003) Trauma, the Body and Transformation: A narrative inquiry. London: Jessica Kingsley Publishers. ISBN 1-84310-106-8.
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Response to Hodgson et al.
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