Society has an uneasy relationship with trauma. It is easier to look away. Austerity has placed our most vulnerable citizens and those who work with them, in precarious positions, which masks suffering. Currently, mental health budgets are inadequate to meet needs meaning survivors are less likely to access appropriate help. Trauma is further compounded for those survivors of sexual abuse, who often suffer prejudice within mental health services and wider society. To ensure that those living with trauma receive justice, it is time that it is treated as both a public health and human rights issue.
When we talk about groups like ‘the mentally ill’ or ‘homeless people’ or ‘young offenders’, we are often really talking about are ‘survivors of abuse’. Mental health problems are multi-factorial. But for many, their ‘mental illness’ can be traced back to awful things happening to them. There is evidence pointing to the links between childhood abuse and mental ill-health; Adverse Childhood Experiences (ACEs) are linked to negative impacts on health and wellbeing. But abuse victims and survivors often have to endure not only primary injury (caused by the abuse) but also secondary injury, as a result of societal reactions towards them.
These secondary injuries can be toxic to wellbeing. Examples are facing disbelief, ostracism, being shamed and suffering further physical harms because of disclosure. Secondary harm can lead to the denial of access to social, scientific and legal justice.
Secondary harm can be seen in a number of areas:
- A lack of narrative justice. Narrative justice is the right to have your story told in a way that reflects the truth of what happened to you. Much of British scientific orthodoxy and societal attitudes continue to reflect a disease model of mental illness that places biological pathology at the heart of mental health problems. This often leads to a masking of child abuse; the failure to recognise historic and unresolved trauma in people’s lives stops us from recognising the population level interventions which need to be taken.
- A lack of social justice. The Children’s Commissioner Report (2015) suggested that only 1 in 8 children who are sexually abused are identified by professionals and that the problem is at public health levels. Many people are never asked whether they have had adverse experiences in mental health settings. Perhaps it is time for mental health professionals to explicitly ask about abuse. Those who do disclose may still be labelled as having disorders in their personalities, rather than being damaged by traumatic injuries. Many do not get access to trauma-informed care, or specialist therapy. Would we have a different response to mental health if we thought of many in the system were victims of serious crimes?
- There are also problems with scientific justice, with survivor accounts historically being denied as based in fantasy. The revelations about Asperger’s treatment of children with disabilities, has also highlighted a sub-story about his attitude towards victims of sexual abuse.
These are examples of society’s denial and obscuring the reasons why many suffer from mental health problems. What happened ‘long ago’ continues today and is likely to be amplified by austerity. We should not think that because ‘science has moved on’ that we are immune to prejudice. It is harmful if science denies the fundamental role trauma has in the development of a whole range of health and social problems.
- Lack of legal justice– Access to legal justice for victims and survivors of abuse is consistently poor, with a high attrition rate of cases proceeding to court and a low conviction rate for those that are heard. There are persistent concerns about the way victims are treated in court, most recently those who testified about sexual exploitation in Newcastle. The trope of victim blaming is easier than looking at the shattering of assumptions embedded in language and structures throughout society.
As this is evidently widespread, we think that this is a phenomenon which is based in prejudice and discrimination, operating in a powerful and structural way against victims and survivors of abuse.
Recent high profile stories of historic sexual abuse of children and adults starkly highlight the negative attitudes and prejudice which victims can face. This is because of what has happened to them, but it also intersects with other forms of identity-based prejudice and discrimination, such as racism or homophobia.
Despite evidence of a lack of social justice for survivors after trauma, there is no adequate terminology (to our knowledge) to capture and recognise these oppressive experiences. This mimics the silence that surrounds abuse itself, an experience which can often be so hard to put into words. We need to move beyond words like ‘revictimisation’, a term which still somehow locates the suffering in the individual, masking the power operating behind further harm. We do need a language to recognise that these secondary, social injuries are taking place.
Across the political spectrum, mental health is becoming easier to advocate for, but it is still underfunded. There are concerns that, in a stretched and stressed landscape, the time and care needed to respond to victims becomes scarce. Under these circumstances, there is a danger that the erasure of abusive experiences becomes worse. It becomes more likely that Society treats the “ill as ill” rather than take pause to consider the stories underneath the label. A human rights approach is needed to respond to abuse. That means not masking trauma behind a label and using medication as the only treatment.
Instead, survivors should get access to high-quality trauma-informed specialists, across the public and voluntary sector. The funding of such services needs to be ring-fenced and secure. And there also needs to be a more widespread awareness of the prejudiced and oppressive practices being used against people who have suffered injury, violence and abuse. There are patterns of large-scale suffering, and this needs a co-ordinated, trauma-informed public health approach to have any hope of responding adequately.
The inequality that faces people with trauma histories highlights the need for adequately funded and responsive public services. Such services need to be survivor informed. We need to change embedded prejudices of ‘the way things are done’, and negative labelling of people who are displaying signs of traumatic injuries.
There is hope. The social activism and examples of inquiry which take account of victim/ survivor testimony (such as the #MeToo movement, and the Australian Report on how trauma affects memory) offer challenge to some of the mythology surrounding gender-based violence and child sexual abuse. But there is a long way to go, and Society has much to do to correct social injustices inflicted on victims. This becomes urgent in a climate of austerity when stress can mean systems become mechanistic and rely on stereotypical thinking.
In an austere landscape, we need to think about what kind of Society we want and to rethink practices which are ethically unjust. This means really listening to victims and survivors and working together to reverse the way powerful structures and institutions amplify and compound the harm caused by abuse.
Simply, victims and survivors deserve better.
About the authors: Dr Khadj Rouf is a Consultant Clinical Psychologist working with adults. She is a member of the British Psychological Society’s (BPS) Safeguarding Advisory Group. She has written professionally regarding mental health issues, and personally from her perspective as a survivor of child abuse. Danny Taggart is an occasional contributor to this blog. See his previous posts on the DWP, mental health stigma and the nudge agenda.