Sexual Abuse and the Primary Care Doctor PDF
Preview Sexual Abuse and the Primary Care Doctor
Sexual Abuse and the Primary Care Doctor PSYCHOSEXUAL MEDICINE SERIES Edited by Ruth L. Skrine MB, ChB, MRCGP Psychosexual Medicine is a discipline which uses a combined body and mind approach to problems related to sexuality, and which stresses the importance of the doctor-patient relationship. The method derives from psychoanalysis but is distinct in that the practitioner listens to unconscious material over a focused, narrow field. The work of many doctors and nurses and of some physiotherapists, provides opportunities for physical examination and treat ment of the genital area which are unavailable to non-medical sexual therapists. Both physical and psychological problems and the interaction between them can be explored at the time of physical examination. This series forms part of the developing body of knowledge held by members of the Institute of Psychosexual Medicine, formed in London in 1974. The books are for doctors and their colleagues who are interested in a psycho somatic approach to sexual problems particularly those working in general practice and gynaecology, as well as psychological and genito-urinary medicine. Other titles in this series Psychosexual Training and the Doctor/Patient Relationship Edited by R. L. Skrine Introduction to Psychosexual Medicine Edited by R. L. Skrine Sexual Abuse and the Primary Care Doctor GILL WAKLEY Principal in a general practice in North Staffordshire SPRINGER-SCIENCE+BUSINESS MEDIA, B.V. First edition 1991 © Springer Science+Business Media Dordrecht 1991 Origina1ly published by Chapman & Hali in 1991 Typeset in Linotron Times 10'/2 on 11 V2pt by Intype, London ISBN 978-0-412-41580-7 ISBN 978-1-4899-2959-4 (eBook) DOI 10.1007/978-1-4899-2959-4 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act, 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the Copyright Licensing Agency in the UK, or in accordance with the terms of licences issued by the appropriate Reproduction Rights Organization outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the UK address printed on this page. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. British Library Cataloguing in Publication Data Wakley, G.M. Sexual abuse and the primary care doctor. 1. Title 362.8 Library of Congress Cataloging-in-Publication Data Available Contents Acknowledgements viii Preface X Foreword by The Right Hon. Lord Justice Butler-Sloss, DBE XV 1 The problem in primary care 1 The limitations of a specialist view What is sexual abuse? Picking up the clues The moment of disclosure The responsibility of the primary care doctor References 2 What is normal? 11 Personal experience is not enough The development of sensuality Sibling relationships Social attitudes and parenting References 3 Adolescent confusions 20 Physical and emotional changes Parents and outside relationships The doctor and the adolescent The absent mother One patient or two? vi Contents 4 Abuse as a 'visiting card' 30 The mother who did not care Contesting for mother's attention Powerless to choose Listening for the real problem The temptations of routine 5 Denial, guilt and excitement 39 The secret relationship Coping with sexual arousal Helping the adult 6 Deeper troubles 46 The index of suspicion More hidden problems Patriarchal power Mothers and grandmothers The cycle of powerlessness References 7 The chronic patient: damage limitation 56 Irritating demands The burden of the incurable How extensive is the damage? References 8 Actions stations: dilemmas for the doctor 62 Effects on the doctor Protecting the child The balance of evidence Both sexes are at risk When all the family are patients Ethical and technical dilemmas References Contents Vll 9 Rape 73 Myths and misunderstandings Reactions to rape The sense of responsibility Releasing the anger References 10 The doctor, the family and other professionals 81 The anxieties of relatives The conflicts for professionals The need for an unshockable doctor Reflected anger and guilt Time for repair 11 Ed~ing forward 88 The aftermath Options for treatment The special needs of the abused child The doctor's personal and professional limits More information needed Prevention The way forward? References Index 102 Acknowledgements I am greatly indebted to all the patients involved in these studies. They are the principal source of education for doc tors and without the study of case presentations no progress in the understanding of this difficult subject could be made. Details from the case histories of some of the patients stud ied by doctors in seminars have been used to illustrate this book. Considerable efforts have been made to disguise any characteristics which might lead to a patient being identified, while attempting to preserve sufficient of the interactions between doctor and patient to give an accurate picture of the encounters described. I must thank all the members of the seminars of which I have been a part, or have led, for increasing my understand ing. Particularly I would like to thank those members of the Institute of Psychosexual Medicine who have provided me with stimulation for examination of new concepts, either from their case presentations, or their insights presented in the discussion of the cases: Dr H. Backer; Dr S. Buck; Dr J. Coombs; Dr K. Draper; Dr M. Gill; Dr J. Gilley; Dr F. Hutchinson; Dr T. Main; Dr A. Morgan; Dr J. Peebles; Dr A. Smith; Dr G. Tattersall; Dr R. Thexton; Dr A. Tobert; Dr B. Tully and Dr P. Tunnadine. However, the opinions Acknowledgements ix and ideas in this book are my own, have been modified during writing, and will continue to change as understanding of sexual abuse progresses. Last, but not least, I must thank Dr R. Skrine and Mr J. Matthews for encouraging me to try to write this book and for their unstinting help in the final stages.
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