During the recent confirmation hearings of now Supreme Court Justice Brett Kavanaugh, I happened to be attending the Nursing Network on Violence Against Women International's 22nd conference, in Ontario, Canada. There, 165 nurses from six continents gathered to share our research on violence against women. It felt significant to us that we were together for this historical moment in U.S. history.
As I listened to Dr. Christine Blasey Ford alleging that she'd been sexually assaulted by Kavanaugh many years before, I felt the impact on a personal level. I recognized in her words and body language a familiar and contradictory inner state. Her truth struck me as much like my own-riddled with ambivalence, shame, and fear of speaking the truth because silence seemed safer and more manageable.
Like Ford, I have sequelae of the experience that I have learned to manage. Like Ford, I have memories that are vivid and details that escape me. But my truth is what I remember. We are made to believe that if a survivor can't remember all the details, then nothing happened. But evidence suggests that traumatic experiences affect how key areas of the brain function and interact, and most victims of trauma have memory lapses of some details.
When survivors share, they open themselves to being vulnerable all over again. Ironically, adverse life experiences can bring one's strengths as well as vulnerabilities to the fore. What is often overlooked in survivors is their resiliency, evidence of which can be seen as inconsistent with their story. All too often the choices made by survivors (not reporting a crime, not seeking medical care) are misunderstood as poor judgment or exploited as proof of a mistruth.
As I listened to Ford, I was also thinking about the impact these hearings would have on my patients. Calls to my clinic began the day of the hearings and have persisted since. One young mother stated, "I was doing okay, but now I'm feeling anxious. I have broken into tears several times today." An 18-year-old college student who had been sexually assaulted sobbed throughout our call: "There is no way I am going to proceed with the police-I'm just going to have to figure out how to live with this." Lastly, I received a call from a senior staff person in my organization, who said, "I have never told anyone, but I think I need to talk to someone." We cannot underestimate the impact that current public events have on survivors and the potential consequences to their health.
As nurses, we can help survivors move beyond surviving to thriving. When I entered the field, I was curious why some women "land" and others struggle in the aftermath of violence and abuse. For me, the answer was clear-the services I needed were there for me. But that is not the case for many survivors. For over two decades I have listened to histories of child sexual abuse, domestic and sexual abuse, and human trafficking. Sharing such sensitive information, even during a health care visit, takes courage and requires trust. It is thus critically important to create safe environments for survivors to share as much or as little of their narrative as they choose.
Ford's experience receiving death threats in the months since her public testimony reinforces the need for a shift in how health care is delivered to survivors. Many organizations are adopting a trauma-informed care (TIC) approach, developed by the Substance Abuse and Mental Health Services Administration. TIC is a framework for understanding the neurological, psychological, and biological effects that trauma has on individuals. It realizes the prevalence of trauma, recognizes its impact on one's health, responds in ways that are meaningful to patients, and avoids retraumatization during encounters.
As nurses we are well positioned to listen for and validate our patients' truths. When we allow their voices to be heard in a safe, nonjudgmental context, we can be catalysts on their path to healing.