sexual abuse

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A new patient came in this week, referred by a trusted therapist. She had been sexually abused at approximately age 7. She was depressed.

She was on a combination of an antidepressant and a sleeping pill. It seemed to work as well an anything would. The medications were the same kind of medications that I would generally use. Older, reliable, out of patent (more than 7 years old) and thus available in cheap generics.

When I asked her how much of her depression it had made go away, she said “50%.” I ordered my usual list of blood tests. They seemed exotic to her.

We couldn’t even tell if they were things she got ordered in her “annual physical.” She had some kind of blood tests done a month ago. She was reluctant to have more drawn, so I told her we could get the old ones. She looked relieved.

?Relieved?
She was visibly overweight. She had paid a well-known diet center to follow their plan. She had gotten down to her “target weight,” then gone on to gain back most of what she had lost.

She was plagued by seborrheic dematitis. This is not usually a difficult thing to control. She could cut her hair (which went down past her shoulders). She could wash it daily with the prescription shampoo that her primary doctor had (correctly) prescribed. She could wear a little cap, perhaps like the sequiny little one that I showed her I had worn that day.

It was plain to see on her face that I was frustrating her, I just seemed to have more solutions than she had problems.

She asked me if she could return for her next appointment in a month.

She was not suicidal.

I made it clear that if I waited one month I would not increase her medication, for she would have to stay on the same if I were to wait so long until seeing her.

She didn’t mind.

She was not alone among my patients to feel as she felt. I have always failed to understand patients such as she.

Her previous psychiatrist and her previous therapist, had dragged her along for approximately two years.

She had contributed to paying their living expenses, with her fees. Maybe they had improved her status some. I mean, to be fair, I had not seen what she had been like when she started.

Depression is common. Far and away the most common of psychiatric illness, no matter what measurements or statistics you believe.

There are aspects of it that clinical trials of medication have shown, time and time again, get better. Things like sleep, appetite, mood, concentration.

Enjoying life, living your dreams, and such do NOT respond to medication.

Having the desire to correct things than annoy you and make your life better; that is somewhere between spirituality and magic for many of my wide-eyed depressed patients.

Sometimes I am angry at my colleagues. They seem to have accepted the limitations put upon them by government and insurance and economics.

This does not much help the patient.

It takes more than a couple minutes in my office to pump up these things.

I have said “stay tuned” before, but now I must try to bring this message to more media.

Science exists, and ought to be serving humankind.

Stay tuned.

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Dr. Alycia A Chambers is one of my new heroes.  An investigation in 1998 led her to suggest that Penn State assistant football coach Jerry Sandusky met the criteria for pedophile, in her own assessment of the person now identified as “victim #6.”

What is at stake here is not the usual legal case of “my expert vs. your expert,” for only the most jaded of lawyers would suggest that this case be deferred to the adversarial system, letting the truth fall where it may.

Sexual abuses of childhood trust generally lead to post traumatic stress disorder (PTSD), which can affect the conduct of an entire life if untreated.  They are all too often untreated.

Dr. Chambers’ report was buried for a long time.  Part of this could have been because she was female.  It is not powerful anymore to talk about sex discrimination and harder to prove it, but I have no trouble believing the opinion of a professional female was buried in the files. Read more on Penn State Coach Scandal Update…

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So many times the cover-up seems to me to be worse than the crime. It might be something as President Nixon and Watergate or as trivial as Sarah Palin and her … um … improvisation on the ride of Paul Revere.

(Don’t try to fool a Boston girl – I know all about Paul Revere).

I think most of us can agree that the alleged sexual abuse of a young boy by a college football coach is definitely on the more serious side. And in addition to whatever reputed sexual trauma may result, there is another severe trauma. Read more on Penn State Child Abuse: The Coverup Is Worse Than The Crime…

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The old guys were right.

Cover of The Maltese Falcon by Dashiell Hammett (1930)I mean the really old guys, the ones who wrote over one hundred years ago.  The guys like Freud and Janet who said that mostly everything that shapes people’s lives seems to be trauma — whether or not modern authors agree.

I have seen an anorectic whose trauma was a passer-by in a crowd who told her that she was too fat for anyone to have sex with, and then keep walking. I have seen a sufferer of OCD (obsessive-compulsive disorder) who was told she was filthy when she was a kid.  She later became so excited about cleanliness she missed nights of sleep to tidy the living room.

But although very real causes of pathology, these seem too trivial to be real traumas for most people.

Others are too horrible to be denied. Read more on PTSD From Sexual Trauma — Learning That Life Is Not Always Fair…

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