National Crime Victims' Rights Week - Part II

by Lucy Puryear, M.D.

As evidenced by our readers' comments in Part I, my patient Elizabeth is not unique. There are many women who have been victims of incest, and other sexual assaults. As I see primarily women in my practice, I know their stories very well; but men are also victims of incest as well as victims of rape. Unfortunately their stories are often never heard due to shame and skepticism. It's been recently that we've come to know the darkness of priests assaulting young boys, revealing more about the impact of sexual abuse on men.

When I first began to see Elizabeth she was very anxious and depressed. Her depression was the primary problem and was potentially life-threatening. She was unable to eat and had lost a great deal of weight in a short period of time. She was tired all the time, felt guilty about all the trouble she was causing her mother, and believed that she had been a problem to her family for a long time. She thought that maybe they'd be better off without her around.

At the least, she said, "If I'm dead, the pain will stop. I'm so tired of trying so hard to be good enough, and always screwing up. I just don't want to be here anymore."

My first job in treating Elizabeth was to make sure that she was safe to be on her own and didn't need to be hospitalized for her own safety. I asked her, "Do you think about ways you might hurt yourself?" Fortunately, she said, "No. I just think about not being here anymore. Like if I could just go to sleep and not wake up, that would be great. But I couldn't do that to my mother. I think it would kill her."

Many people with depression have thoughts of death but no plans to actively hurt themselves. This is critical information in order to continue to treat someone as an outpatient. I started Elizabeth on antidepressant medication and recommended she see me once a week for therapy. I also referred her to the rape crisis center in Houston for support, and possible group therapy.

There are themes common to all incest victims and victims of sexual assault that I often hear in therapy. For Elizabeth, she had to deal with the shame and responsibility she felt for the abuse by her stepfather. She wondered, "Why didn't I tell him no, or run out of the room? Why didn't I tell my mom? She would have believed me and it would have stopped. He was mean to her too. Maybe there was part of me that wanted that? Is that possible? I always took the ice cream or candy afterwards."

As an adult looking back, a survivor of sexual abuse might find it hard to understand why s/he didn't say no . . . why s/he didn't run away . . . why s/he didn't tell someone . . . anyone. But a child's mind does not function like an adult's.

A child assumes that adults are there to protect them from harm. It's confusing when the stepfather you are told to love and trust hurts you. You want attention, but the attention is confusing. You are young and he is old; you do what you're told. And it doesn't stop because the person who tells you that he will kill your mother if you tell is more powerful than you and you believe him. You are small and he is big. And you're afraid that if you tell you might be taken away from your mother. So you pretend that there's no problem and you try to be really, really good. But as an adult you feel ashamed and guilty for your participation. You've forgotten how helpless you felt as a five year old. Elizabeth must learn to forgive herself for being five and doing the best she could at the time.

Women who are victims of sexual abuse often grow up feeling dirty and damaged. There is something broken in them that will color how others see them and treat them. It's why often women who have been abused will tolerate being partnered with another abuser. They believe that they are somehow worthless and when someone gets in close they will know how awful they truly are. The abuse, whether verbal or physical, makes sense.

Some women who are abused go on to lead ruined, damaged lives. Elizabeth was walking down this path with her promiscuity and drug and alcohol abuse. The unconscious belief is, If I treat myself this way I am making that choice, I am not powerless, what happened to me was not that big of a deal, I am in control.

If this behavior doesn't stop, lives become more and more desperate and sad. Many women though, like Elizabeth, tell themselves that they will not let the abuse ruin their lives, they will be successful and prove that they have value. But without therapy or some type of working through the abuse the feelings I have described remain. These feelings can have long-term effects on future relationships with friends and loved ones. They remain vulnerable and hurting.

Once someone has been through a traumatic event another traumatic event is much harder to process. It's as if the brain has been primed to respond to trauma. Elizabeth processed the rape in much the same way she internalized the sexual abuse. She believed that the rape was somehow her fault. That there was some flaw in her that made the rapist chose her. That if she hadn't been so stupid as to be walking alone at night, it wouldn't have happened. She had a hard time blaming the rapist for his actions; she was more responsible than he. The rape confirmed her fears that she was damaged and dirty. She didn't report the assault to the police because she was ashamed of herself.

Elizabeth and I spent many months together talking about how a child is not responsible for an adult's abuse. She didn't run away because she was confused and scared and didn't have the maturity to process other choices. She was a child, she was blameless. We talked about the sexual assault on campus being similar to what happened to her as a child. A man bigger and more powerful than she took control and abused her. At the time she was helpless to stop him. We talked about her allowing herself to be angry at her stepfather and the rapist for hurting her. She even allowed herself to express anger at her mother for not realizing what was happening to her as a young child and stopping it.

I am still seeing Elizabeth. She is no longer depressed and has graduated from law school. She is employed and volunteers as a child advocate at the court. We are working on her acknowledging her worth and value and allowing her to have a close relationship with a man who respects and cherishes her. That is still hard for her.

All stories are different and people react differently depending on earlier life experiences. But victims of sexual crimes are left with a particular set of feelings about themselves and their worth as women. There is healing for those feelings and women can recover and lead healthy and productive lives. It is an honor to work with these women and to help them to heal.

National Crime Victims' Rights Week - Part I

by Lucy Puryear, M.D

In honor of National Crime Victims' Rights Week, I would like to present a case of mine that tells the inside story of someone suffering from being the victim of crime. In Part One, I will present her story. In Part Two tomorrow, I will discuss the case and talk about the after effects of incest and rape. This is a real story, although details have been changed and identifying features altered to protect confidentiality.

Elizabeth was a young girl of three when her stepfather began molesting her. She doesn't remember much about those early years, but has vague memories of being scared at night and not wanting to be left alone with her stepfather. Her mother told her that she was frequently treated for urinary tract infections when she was little.

At the age of five, Elizabeth remembers her stepfather calling to her from the garage, "Come help me fix your brother's bike." She was both excited and uneasy. Excited that her stepfather was asking for her help and uneasy that she would be alone with him, away from the eyes of her mother. "Come on, we'll go for ice cream afterwards." It was the first time she remembers her stepfather putting his fingers inside of her and more. It wouldn't be the last.

The abuse happened until she was thirteen. It stopped when her mother and stepfather divorced and her mother and she moved out of town. She never told her mother or a teacher or her best friend. Her stepfather told her not to tell or he'd kill her mother. She believed him and kept her mouth shut.

Elizabeth got good grades in school, was in Girl Scouts, and sang in the church choir. No one ever asked her if there was anything wrong. No doctor ever questioned her urinary tract infections. Her mother never wondered why Elizabeth tried to avoid being alone in the house with her stepfather.

In high school, Elizabeth started getting in trouble. She started hanging out with the "cool" kids and would meet up with her friends to smoke pot before school started. Drinking and other drugs followed and her grades began to slip. Drinking and drugging were an everyday occurrence and sex with any boy who showed her some attention was not uncommon.

Elizabeth's mother couldn't understand why her daughter was acting so out of character. She had been a sweet child and always willing to do any chore that was asked of her. She never complained and seemed to get along with everybody. Although Elizabeth never seemed very popular or had friends over to the house, her mother thought it was just because she was shy and liked spending time with her mother. She considered them to be very close.

In college, things seemed to turn around. She was able to get a scholarship to a small college out of town. Elizabeth decided it was time to turn her life around and put the past behind her. She made great grades and some good friends. No more drugs or alcohol and no more promiscuity. She was determined to go to law school and make something of herself. She wasn't going to be a victim to what happened to her as a child.

In law school, Elizabeth was studying late one night in the law library. Constitutional law was her most difficult and most interesting class. She wanted to do well in the hopes of getting a prestigious clerkship.

"I wanted my mom to be proud of me again. I know I had let her down when I was in high school. I was a really bad kid and caused her lots of grief," she told me on her first visit to my office. "I was raped that night. I caused her grief again."

Elizabeth was referred to me three months after she was attacked and sexually assaulted by a man who accosted her as she walked across the semi-dark campus. She didn't recognize the man and was unable to recall any distinguishing features. She just remembered his voice telling her not to scream or he would kill her. She thinks he had a knife but was too frightened to check. When he finished he told Elizabeth not to move for an hour or he would come back for her. She lay there for what seemed like forever before she found the nerve to walk home. She did not report the assault to the police.

"I was just in the wrong place at the wrong time," she said. "It was stupid of me to be walking alone that night. I was just asking for trouble, at least he didn't try to kill me. It could have been a lot worse."

Elizabeth had taken a leave of absence from law school and moved back home to be with her mother. She had not told the school about the assault, only saying that she was ill and would need to take some time off.

In my office I saw a woman severely depressed. She wouldn't look me in the eye, sat on my couch wringing her hands, and couldn't stop crying. She had lost twenty-five pounds in the last three months and was close to being hospitalized for the effects of malnutrition. Elizabeth kept repeating over and over again, "It's all my fault, it's always been my fault."

Please share your thoughts and feelings about Elizabeth and how you might go about helping her. In Part II tomorrow, I'll post my thoughts and relate how Elizabeth is doing.

The East Mountain Triple Homicide

by Donna Pendergast

It's going on a decade since that night in May