Many who were abused in childhood were unable to protest, or tell about the abuse, or even express appropriate feelings. In order to survive, they searched for ways to cope with and protect themselves from the pain. They may have tried to remove themselves from the reality of the pain by going numb, going 'away' or forgetting. But memories and feelings don't go away. They go underground. Some found that the only place to bury the pain was in their bodies.
'Sally' was the third client in as many weeks to tell me of her painful experiences with sexual abuse and endometriosis. The doctors could not cure her chronic pelvic pain, and she saw them as impatient with her intractable illness. Her pain and shame over her history and present condition were inextricably entwined. In listening to her story of physical and emotional pain, I wanted to understand more about the connection between gynecological disorders and earlier sexual abuse.
Many in the field of mental health have written about the long-term effects of sexual abuse on a woman's body, but what did researchers in the psychology and health professions have to say? Until recently, not much. Among the few research articles published on this issue is one by Jean Cunningham, et.al., in the Journal of Interpersonal Violence, June, 1988, that compared the medical complaints of 27 women with a history of sexual abuse to a control group of 33 women who reported no such history. They found that the sexually abused women, who also reported a much higher incidence of childhood physical abuse than the control group (44% vs. 9%), experienced a greater number of medical problems, including headaches and asthma, as well as gastrointestinal, gynecological and reproductive difficulties. Andrea Rapkin, et.al., (Obstetrics and Gynecology, July, 1990) also found a significant correlation between childhood physical as well as sexual abuse and chronic pain, especially pelvic pain.
Dr. Edward Walker, M.D., and his colleagues at the University of Washington are in the forefront of this research. In January, 1988, they published an article in the American Journal of Psychiatry exploring the relationship between chronic pelvic pain and childhood sexual abuse. They found that, out of 55 women undergoing exploratory laproscopies for specific pathologies, the 25 women with chronic pelvic pain had similar types and levels of pathology as the 30 women in the control group who did not present with chronic pain; however, they had double the incidence of remembered sexual abuse in their histories (64% as opposed to 23% for the control group), and a higher rate of sexual dysfunction and depression. In an article (unpublished as of June, 1991) exploring the relationship between the experience of chronic pelvic pain and the tendency to use dissociation as a coping mechanism, Dr. Walker and his associates offered a construct of the development of somatization, dissociation and pain symptoms in those with a history of early sexual abuse. They suggested that chronic pelvic pain may represent a body 'memory' of the abuse that may not be recalled consciously. They also suggested that women experiencing this pain may benefit from psychotherapy, as well as pharmacotherapy. Others in the Seattle area agree.
Dr. Charles Thompson, M.D., and the team of physicians, psychologists, nurses, physical therapists and counselors at St. Luke's Medical Center, have based their clinical practice on the belief that 'the journey towards wholeness and well-being involves the integration of physical, psychological and spiritual factors.' Dr. Thompson asserts that some physical manifestations of distress, such as chronic pain, premenstrual syndrome, autoimmune disorders and allergies are frequently associated with early trauma. He calls such physical disorders, 'story tellers''that is, ways to express traumatic memories and feelings that can find no other outlet. Dr. Thompson and his colleagues use a team approach to assist those that are hurting to examine the sources of their pain and to become active in the healing process.
Those of us in the medical and mental health fields who are working with people whose physical and emotional distress may reflect previous trauma need to honor the messages that pain brings, whatever the source. We cannot know whether or not an individual woman's physical pain is connected to previous psychological trauma. Even if there is such a connection, it could be quite harmful to assume that a woman consciously recalls the trauma, or that she is ready to discuss and deal with it. What we can do is to inquire and listen with open-mindedness and gentleness. We can allow time for a trusting relationship to be established before beginning to discuss this issue. We can also increase communication and referral between medical and mental health practitioners.
Sally is still in pain, but her shame is abating. She, and other women, are beginning to listen to the stories coming from within them, as all of us who work with women like Sally are increasingly listening to her and each other.
Reprinted with permission from:
Evolving Community, Spring/Summer, 1992
Faith Rayman, M.A. has a private practice where she works with people experiencing the effects of childhood trauma, people recovering from addictions and co-addictions, and people going through life-style, marital and career transitions.