Last fall, during the closing keynote session of the International Association of Forensic Nurses' International Conference on Science and Practice, I had the opportunity to hear Attorney Claudia Bayliff speak about how language shapes our responses to sexual violence. For many years, I have contemplated the nuances of language as a nurse, a writer, and a researcher. I was struck by her candor and intrigued by her commitment to issues related to sexual assault. Moreover, I felt my own beliefs regarding language had been validated. I have long believed that the words that we use, and the associated attributions that we make, strongly influence our actions in practice. Yet, the language of sexual assault is exceedingly murky for healthcare professionals and lay people alike. Most recently, in my role as Editor-in-Chief of the Journal of Forensic Nursing, I have noticed that, when it comes to sexual assault, authors and reviewers, novice and expert alike, frequently struggle with how to appropriately refer to the person who has been sexually assaulted: patient, victim, or survivor? I recall one manuscript in particular whereby the authors used the term "victim"-one reviewer suggested the authors change "victim" to "survivor" throughout their manuscript, whereas another insisted that "patient" needed to be used. Having had a few similar experiences of late, I was inspired to contact Bayliff and further pursue her ideas surrounding language. As such, my purpose in writing this editorial is twofold: (a) to challenge you to think about the language that you use in your day-to-day practice as a forensic nurse; and (b) to showcase Bayliff's critical approach to education and practice in this area. What follows are some insights gleaned from our recent conversation. I hope you will be motivated to develop further clarity in what you do and believe, and that you continue to be mindful of the language that you use and how your language may affect outcomes.

More Than Semantics

Patient, victim, or survivor? What thoughts come to mind when you hear each of these words? Consider your choice of language and your responses to it. For example, Bayliff poses the question: "Do you wince when you hear the word 'victim'?" Sadly, how we treat victims tells a lot about ourselves. We need to think about our own processes and become cognizant of our responses, particularly if and when we become aware that we are having a negative reaction to the person who has been sexually assaulted. Moreover, although Bayliff does not believe that one term is necessarily better than another, as such labels often are context specific, she deliberately chooses to use the word "victim" in her presentations and seminars and in her practice as a lawyer. Regrettably, she concludes that the word has become pejorative, which has translated into a backlash against victims. Language, of course, is not neutral or impartial; rather, it reflects our perceptions, biases, and prejudices. Bavelas and Coates (2001), in a discussion of language used in trial judgments, state that "language can never be neutral; it creates versions of reality" (p. 29).

Do we equate victimization with weakness? Does the word "victim" imply passivity? Acceptance of one's circumstances? Causality? Do we then blame the victim? Many advocates on the other hand prefer to use the language of "survivor" in reference to the person who has been sexually assaulted, claiming the term is one of empowerment and can lead to the person taking charge of his or her circumstances and eventually thriving. The trouble with "survivor" is that the label, in and of itself, may be too much for the person to bear, as he or she may not feel like a survivor. Moreover, although survivor is an accepted term among the advocacy community, Bayliff is of the opinion that the term is somewhat contrived. Building on the work of Clifton Spargo, she observes that we need to "reclaim 'victim' as 'survivor' is an empty term without the premise of victimization under it." However, what about the term patient (or client), which is clearly oriented to forensic nurses and other healthcare professionals? Inherent in their professional roles is the requirement of remaining objective, and because of this, nurses and other healthcare providers cannot cloud their roles and responsibilities surrounding objectivity by assuming roles and responsibilities associated with victim advocacy. Defining their responsibilities within the context of the nurse-patient relationship helps solidify their role and their raison d'etre. In short, "language shapes how nurses define the nature of their presence" (Mitchell, Ferguson-Pare, & Richards, 2003, p. 49) with those in their care. In deciding on our choice of language, Bayliff suggests that we learn to take our cues from the person with whom we are working. Moreover, we must ensure that we see the "person-as-a-person" (MacMurray, 1961) and not solely as a patient, a victim, or a survivor.

Unaccountable Language and the Invisible Perpetrator

Frank and Goldstein (n.d.) state that "unaccountable language refers to the powerful messages embedded in all forms of speech and media that have all of us lapse into sentence structure that obscures perpetrators, minimizes their abuse, and supports blaming victims" (para. 3). Likewise, Bavelas and Coates (2001) observe that the language that we choose can have a profound impact on how the crime and its consequences are perceived. Moreover, although much of this discussion of language is likely familiar to forensic nurses, Bayliff emphasizes the importance of avoiding words such as "claims" or "alleges" when documenting the victim's history, as such words cast doubt on the victim's account of the events. When documenting the history of a patient who has been sexually assaulted, it is important to find factual ways to cite the history. For example, use the client's words, enclosed in quotation marks, and avoid value-laden terms such as "the patient was 'drunk' or 'passed out'." Instead, indicate that you could smell alcohol on the patient's breath or that the patient was difficult to arouse. It is also best to avoid phrases such as "no distress noted" or "no trauma noted," as such phrases can be too easily misinterpreted; they clearly have different meaning to police, judges, prosecutors, defense attorneys, and jurors than they do to nurses and other healthcare professionals. Instead, state "no visible injuries noted." Furthermore, think about the word picture that the language creates. For example, be sure to construct sentences that do not obstruct the agency (and responsibility) for the act. To illustrate this further, she draws upon the work of Jackson Katz. Consider the following sequence: (a) Andrew beat Jessica, (b) Jessica was beaten by Andrew, (c) Jessica was beaten, (d) Jessica was battered, and (e) Jessica is a battered woman. Bohner (2001) states that such linguistic avoidance not only deflects the responsibility away from the perpetrator but also diffuses the situation so as to remove any identified perpetrator altogether.

In a recent article addressing how language matters in our responses to sexual violence, Cooper (2015) discusses how words that are used to describe sexual assault can "linguistically blur rape with healthy consensual sex"(p. 11). For example, Bayliff observes that stating that the child "performed oral sex" sounds like a voluntary act, one of mutuality, as opposed to the man "forced his penis in her mouth." Those two constructions create dramatically different word pictures. In addition, euphemisms such as "child pornography" or "kiddie porn" minimize the violence inherent in such acts, as does using the language of "date rape" or "acquaintance rape."

Commitment to Education

Bayliff has been working in the field of sexual assault as a volunteer, educator, and lawyer for 27 years, in a variety of capacities from the micro to the macro and everything in between. Her first foray into this field was as a volunteer hotline crisis counselor with the Boulder County Rape Crisis Team in March 1988. She was later appointed as the first Chief of the Unites States Air Force's worldwide Sexual Assault Prevention and Response Program. She currently serves as the project attorney for the National Judicial Education Program-Legal Momentum, developing a national curriculum to help victim advocates provide legal advocacy for sexual assault victims navigating the criminal justice system. In her private practice, she has developed and implemented educational curricula about sexual assault for judges, prosecutors, and other criminal justice professionals. She teaches and consults about violence against women across the United States, Canada, and Europe. However, it was during her 500 hours of pro bono work on the Kobe Bryant sexual assault case that she first recognized the power of the discourse surrounding sexual assault. During the trial, the defense attorney "skillfully controlled the narrative"-no longer was the victim a victim but an "accuser." Although deconstructing the language surrounding sexual assault is critical to her current work, she states that she is not so naive as to think that simply finding the right words or coming up with the right language will prompt people to stop blaming victims and start holding perpetrators accountable. However, language does play a critical role in this work-it shapes our responses and creates potent word pictures.

Closing Thoughts

Not surprisingly, language features in Bayliff's self-care, as she finds solace in reading. In fact, she is a veracious reader of food-related books-recipe books, memoirs, and biographies of chefs-stating "nobody dies or gets raped in food books." On a more serious note, she observes that she does not "see the world as a horrible place filled with perpetrators." Embedded in these comments is a lesson for all of us-the importance of nurturing the soul. Otherwise, it is too easy to become jaded, and see the world negatively.

If you ever have the opportunity to hear Bayliff speak, do so; I guarantee you will not be disappointed. Moreover, although you may not agree with all her assertions or with the underlying premises of her thesis, I hope that this editorial will challenge you to think critically about this topic, will simulate discussion between you and your colleagues, and will encourage you to choose your words wisely.

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