The sky angry. The waters murky. The fear that at any moment a sudden undertow may drag you deeper into violent waters. A creature brushes your leg, friend or foe unknown. You become paralyzed by fear, anxiety and hypervigilance. You hear someone shouting to you from somewhere far into the distance, “Get out of the water!” But you cannot see the shore.
Women live in a world of fear. This is not to say that other groups of people do not suffer the same fate. However, as discussed by Kate Harding in her decisive book Asking For It, no other group of people is asked universally to change its behavior in acceptance of the burden of preventing sexual violence. (“She shouldn’t have been wearing that. She shouldn’t have gone there alone.”) No other group is universally brought up to believe that at any time, at any moment, articulations of beauty, sexuality or humanity could bring violence. Women are brought up in an environment where sexual violence is tolerable, natural and inevitable.
Rape culture is the sea that has no shore. It is defined by Buchwald, Fletcher, and Roth as “…a continuum of threatened violence that ranges from sexual remarks to sexual touching, to rape itself.” It is a collection of policies and practices that support victim blaming and disbelief. It is the accepted narrative of a trivial event. Rape culture is a flow channeled unintentionally or not, directly or indirectly, by countless individuals in powerful societal institutions. Medicine is one of those institutions.
By way of medicine, survivors of sexual violence seek the shore. They come to the emergency room seeking care immediately following an assault. They come to the primary care office for resultant anxiety, depression, PTSD and chronic disease. Yet many survivors face practitioners who deeply believe the myths that most women are lying about sexual violence or that sexual violence is a trivial event. Worst of all, many survivors find themselves the victims of sexual violence or retraumatization at the hands of the practitioner themselves.
Recently, I worked in the emergency room. A 16-year-old with a history of bipolar disorder awaited a bed in an inpatient psychiatric facility. She claimed to have had been raped by an acquaintance at a party. Because she had been unpleasant to the ED staff since her arrival and because her story of rape changed in minor details over time, nobody took her accusation of rape seriously. No one believed her. “I guess we will have to call the SANE nurse,” I heard someone begrudgingly say.
Experiencing sexual violence at the hands of practitioners themselves is also a continuum of subtle to overt. There’s the well-meaning practitioner, who in a misguided attempt at demonstrating empathy, sits uninvited on a patient’s bed. There’s the well-meaning practitioner, who in an attempt to guide a patient through a pelvic exam says, “Please spread your legs” instead of, “When you feel ready, let your knees fall to the sides.” (As if saying ‘please’ makes the demand okay.) And then there is the well-meaning practitioner, who is so steeped in rape culture and the power dynamics of medicine, that without consent or warning, spreads a patient’s legs for her. Then there is the comatose women who was raped by a staff member in her long term care facility and recently gave birth. And do not forget the gymnasts who were repeatedly raped by their physician, Larry Nassar.
I have been personally subjected to the culture of violence in the medical field in more ways than one. One event most devastating to me is one that I did not recognize until much later. Alone in his office on a quiet day, an OBGYN demonstrated a procedure on my upper thigh. Soon thereafter, I heard a story about this same physician from another staff member who had seen him for the first two-thirds of her pregnancy. At some point, she decided to seek care elsewhere. A few months after my own incident the physician ended up suddenly “leaving practice” for a tightly kept, undisclosed reason. I find myself wondering if there had been other women subjected to his touch after me and if I could have done something to stop it.
Those who perpetuate violence in medicine do so directly or indirectly by eliminating their own feelings. Rebecca Solnit writes, “Empathy is a narrative we tell ourselves to make other people real to us, to feel for and with them … To be without empathy is to have shut down or killed off some part of yourself and your humanity, to have protected yourself from some kind of vulnerability.” A healer who participates in direct abuse is a victim of rape culture, having numbed the part of themselves that registers empathy. As either survivors of direct abuse in the medical field or witnesses to it, our silence joins us to the abusers in their numbness. This is the recipe for a callous, cold, unwelcoming and unsustainable medical environment — not a healing one. The stories above remind us that rape culture is not only subtly present in but is dominant to our American medical tradition.
Medicine is a profession that relies on dogma and is hard-pressed to make changes without irrefutable evidence. Where medicine has failed undeniably is the dogma of its dogma — it has failed to accept the discomfort that is inherent in questioning its core beliefs about how it values women as patients, practitioners and human beings. Medicine is unwilling to ask what real consent looks like. It is unwilling to accept its real responsibility, which is to recognize its own humanity and protect it in our patients. We in medicine are bred in toughness and weeded out when we begin to examine or show signs of our own vulnerability.
As both medical providers and humans, we know healing is uncomfortable. Even something as small as a paper cut becomes itchy as it heals. As healers, we must be willing to face the discomfort of exploring our bias. Doing so begins with deep listening to ourselves and then to our patients. When we are aware of our feelings and biases, our self-understanding expands and so does our willingness and our capacity to understand others. When listening to patients, we must recognize that which is in direct opposition to our core beliefs. As Thich Nhat Hanh writes, “Understanding is love’s other name.”
Our other job as healers is to gather this truth and make sense of it. The truth creates space for healers to grow into their empathy instead of learning to be numb to it. The truth has the power to build a community of practitioners who believe in the equanimity of all people. The truth will encounter resistance, but we must not be afraid of it. Our work is not to simply swim alongside patients in murky waters, but is to understand and transform the nature of the water itself. Changing rape culture in medicine is our work because it is the work of transformation and the work of love.
There is no one at the top of the medical hierarchy preventing us from changing ourselves. What of instead of creating a just a shore, we too change the makeup of the sea?