Out of the silence: towards grassroots and trauma-informed support for people who have experienced sexual violence and abuse

TY - JOUR

T1 - Out of the silence: towards grassroots and trauma-informed support for people who have experienced sexual violence and abuse

AU - Sweeney, A.

AU - Perôt, C.

AU - Callard, F.

AU - Adenden, V.

AU - Mantovani, N.

AU - Goldsmith, L.

PY - 2019/4/12

Y1 - 2019/4/12

N2 - To experience sexual violence and abuse is to experience silence. This commentary explores some of the ways in which psychiatry reinforces the silencing of sexual violence survivors. We argue that current psychiatric responses to sexual violence typically constitute iatrogenic harm including through: a failure to provide services that meet survivors’ needs, a failure to believe or validate disclosures; experiences of medicalisation and diagnoses which can delegitimise people's own knowledge and meaning; ‘power over’ relational approaches which can prevent compassionate responses and result in staff having to develop their own coping strategies; and poorly addressed and reported experiences of sexual violence within psychiatric settings. We argue that these multiple forms of silencing have arisen in part because of biomedical dominance, a lack of support and training in sexual violence for staff, inconsistent access to structured, reflective supervision, and the difficulties of facing the horror of sexual violence and abuse. We then describe community-based and grassroots responses, and consider the potential of trauma-informed approaches. Whilst this paper has a UK focus, some aspects will resonate globally, particularly given that Western psychiatry is increasingly being exported around the globe.

AB - To experience sexual violence and abuse is to experience silence. This commentary explores some of the ways in which psychiatry reinforces the silencing of sexual violence survivors. We argue that current psychiatric responses to sexual violence typically constitute iatrogenic harm including through: a failure to provide services that meet survivors’ needs, a failure to believe or validate disclosures; experiences of medicalisation and diagnoses which can delegitimise people's own knowledge and meaning; ‘power over’ relational approaches which can prevent compassionate responses and result in staff having to develop their own coping strategies; and poorly addressed and reported experiences of sexual violence within psychiatric settings. We argue that these multiple forms of silencing have arisen in part because of biomedical dominance, a lack of support and training in sexual violence for staff, inconsistent access to structured, reflective supervision, and the difficulties of facing the horror of sexual violence and abuse. We then describe community-based and grassroots responses, and consider the potential of trauma-informed approaches. Whilst this paper has a UK focus, some aspects will resonate globally, particularly given that Western psychiatry is increasingly being exported around the globe.

KW - Health service research

KW - psychiatric services

KW - sexual assault

KW - trauma

UR - http://www.scopus.com/inward/record.url?scp=85065333939&partnerID=8YFLogxK

U2 - 10.1017/S2045796019000131

DO - 10.1017/S2045796019000131

M3 - Article

SN - 2045-7960

SP - 1

EP - 5

JO - Epidemiology and Psychiatric Sciences

JF - Epidemiology and Psychiatric Sciences

ER -