Do You Care About Abuse, or Do You Just Pretend To?
By: Karin Kerfoot
Tags: Violence Against Women, Systemic Abuse, Trauma, Abuse, Gender Based Violence

More than ever, we are confronted by the fact that abuse is all around us. Unfortunately, lots of people are abused by somebody else in ways that are very damaging physically, sexually, or mentally. Sometimes fatally. This is a difficult truth to acknowledge and, for that reason, many people choose not to. I encountered this regularly in my clinical practice working with victims of all kinds of abuse.

Consider the following scenarios:

A woman is plagued by intrusive memories and nightmares of the abuse she suffered as a girl at the hands her father. He beat her, forced her to have sex with him, and told her that he’d kill her if she ever told anyone about what he had done. Although he avoided going to jail for his crimes, he was found legally responsible for what he did to her. Still, several people in the woman’s family refuse to acknowledge that her father did anything wrong, instead insisting that he is a good and honourable man. They accuse her of lying, and of breaking up the family. Given that her father got off so lightly and that even her family won’t stand up for her, the woman worries that she and other women are not safe from him.

A woman contacts the police to report that she has been beaten and raped by a man who lives in her apartment building. They live in subsidized housing, and the police are called frequently to that particular building in order to deal with multiple issues, including drugs and violence. The woman is injured and distraught when the officer arrives. Even still, he dismisses her account of what happened to her and simply admonishes her to be more careful. She seeks medical attention and, several days later, works up the courage to go directly to the police station to try again to report the assault. Much like the first time, she is dismissed and the police take no action against the man who raped her. She has no other housing options and decides that the only way to stay safe is to remain hidden in her apartment as much as possible.

These scenarios are based on real cases that I encountered as a psychiatrist. They are just two examples of many where people chose not to acknowledge abuse and violence that there was little doubt had occurred. As you can see, often it wasn’t just family or friends who decided that the abuse was too difficult or complicated to address; many times it was the police or some other authority responsible for protecting victims.

Confronting abuse, whether it occurs in a family, workplace, or community, is never easy. In reality it is painful, draining, and disruptive. Sometimes it can mean acknowledging that someone you care about, such as a family member or a colleague, did something to hurt someone. That’s a difficult emotional and mental dissonance to overcome for anyone. Almost always, the abuser denies what they’ve done, and it takes time and effort to sort out the truth. If you’re a responsible institution you can get sued if you don’t do the massive amounts of paperwork necessary to cover your liability for any action you choose to take. It’s often so much easier to just ignore it. Yet, if you care about protecting people from abuse, ignoring it has to be unacceptable.

If you are committed (or mandated) to solve the problem of abuse, but find the problem daunting, it is tempting to avoid the inherent complexities and grey areas, and instead create simpler, black and white rules to help you tackle the issue. Rather than defining abuse by what it is, why not use easier proxy measures and draw lines in the sand around anything that might approach abuse? These types of zero-tolerance policies are intended to make it easy to identify abuse and abusers or, better yet, prevent abuse from happening in the first place. With this approach, the idea is that anyone can quickly check a box on a handy cheat sheet in order to “target abuse”. But, if you care about stopping abuse and helping victims, does this actually accomplish your goal?

Consider the following scenario:

A woman develops severe depression following the birth of her second child and is admitted to hospital for psychiatric treatment. Her husband speaks with a social worker, hoping for support and guidance while his wife is ill and he is caring for her and their children. Shortly after that, the woman is placed under investigation by children’s aid services and ordered to comply with a series of intrusive meetings and home visits. She has been identified as a risk to her children because of her psychiatric illness.

In this scenario, also based on a case that I encountered in my clinical practice, there was no evidence or reason to think that the couple’s children had been harmed or put in danger. The family had support from several relatives, and the children were very well cared for. Still, the woman’s mental illness was one of the checkboxes used by the system to “solve” abuse and violence. The woman had a mental illness that, in a relatively small number of cases, has been linked to violence against children. So, she was put on a list. Many resources were spent on multiple home visits and the piles of paperwork mandated because someone had checked off a box. The couple was left angry and ashamed, while cases of real abuse remained undetected and overlooked.

A similar story has unfolded in the regulation of medicine and the physicians who practice it. As a self-regulating profession, medical doctors have always been responsible for dealing with fellow physicians who abused patients. Unfortunately, there are far too many cases where very real, damaging abuse of women patients has been overlooked and ignored by these self-regulatory bodies. It has to be acknowledged that physicians have a very poor track record when it comes to dealing with abuse by their own colleagues. Predatory doctors have been allowed to continue to practice, accumulate multiple victims, and some only had their medical licenses taken away after they were found criminally guilty and sent to jail. Given these failures, doing the hard work of identifying and addressing abuse was something that we physicians clearly demonstrated we weren’t good at when the career of a colleague was on the line.

In order to prevent this from continuing to happen, several governments have taken matters into their own hands. In my province, the government passed a zero-tolerance law that states that any sexual contact at all between a physician and a patient is to be considered abusive, and that the physician’s medical licence must be revoked. Perhaps you feel that this is reasonable, given the potential power differential between a physician and a patient. Perhaps you believe that rules like this prevent doctors from preying on their vulnerable patients.

But consider these scenarios:

A doctor sees a woman as a patient once at a walk-in clinic. They have some mutual acquaintances and run into each other socially several times after that before their relationship becomes sexual. When the woman’s husband discovers their affair, he is incensed and contacts the physician’s medical regulatory body in order to get revenge on his wife and her lover. Despite the woman’s repeated assertions that their relationship was consensual and that she was not harmed or abused by the physician, the doctor is found to be guilty of sexual abuse and his medical license is suspended in order to protect the public from him.

If you care about abuse, you need to ask yourself: Who had the power in this scenario? Many people have affairs and you may feel strongly that the doctor acted poorly, but was he abusive?

Despite the fact that physicians should not treat family members (for many reasons), a physician provides medical care to his spouse. When his licensing body discovers his transgression, they not only sanction him for this action but also accuse him of sexually abusing a patient, because he is presumably in a sexual relationship with his wife.

If you care about abuse, you need to ask yourself: What is motivating the actions of this regulatory body? Who are they trying to protect?

In a rural community, a man sees a physician at the local clinic for stitches. Many months later he meets the physician again, but this time because he is coaching the doctor’s son’s hockey team. Both are single parents. One thing leads to another and the doctor and coach fall in love. They are the happy talk of their small town until the physician’s licensing body learns of their relationship and accuses her of sexually abusing her patient. Her medical licence is suspended and the community loses its physician.

If you care about abuse, you need to ask yourself: Is this the outcome you would hope for?

A serial predator lures, coerces, and rapes multiple women. He meets several of these women through hospital stays and in associated clinics. One of his victims is his psychiatrist. For a year, he repeatedly threatens, extorts, and physically and sexually abuses her. When she finally stands up to him to protect herself and another one of his victims, he sets out to destroy her by filing a complaint with her licensing body. She is accused of sexually abusing her rapist and her medical license is revoked in order to protect the public. From her.

All four of the above scenarios are based on real events. The first three I learned about from several sources and I believe them to be true. Unfortunately, the last scenario describes my own case — I am the physician who was abused and raped by a man who was my patient. Were these the types of scenarios that lawmakers had in mind when they made their rules? Though they set out to prevent physicians from abusing their patients, do you believe that their zero-tolerance policies did what they intended to do?

Based on my experience of working with many victims of different kinds of abuse, as well as my own experience as a survivor, I strongly believe that the zero-tolerance, checkbox approach to identifying or preventing abuse does little to no good, and often substantial harm. Simple systems are easy to manipulate and not infrequently become tools of abuse themselves, as you can see from some of the scenarios I described. I have talked to many people who have suffered real, very traumatic abuse, and none of them were helped by simplistic, zero-tolerance policies. Many were ignored and abandoned by these types of systems, even though they are supposed to be there to help them.

If you care about abuse, and you’re not just interested in appearing to, I would suggest that you need to advocate for systems that do the hard work of actually identifying and confronting it. Each individual circumstance has its own unique complexities and nuances, and if you want to actually address the real problem you cannot escape the hard work of delving into them. Otherwise you will fail to make a real difference. Preventing abuse is a huge and multi-faceted issue but, in my experience, zero-tolerance rules don’t help.

Despite the increasing attention to abuse and all the strong words of clamping down on it, very real abuse continues to happen every day and abusers are still getting away with it. If you do care about abuse and want to work for real solutions, filling out checkboxes instead of addressing the real problem has to be unacceptable to you.