Sexual Abuse and the Primary Care Doctor

122 Pages·1991·2.19 MB·English

by  Gill Wakley (auth.)

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
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The publisher makes no representation, express or implied, with
regard to the accuracy of the information contained in this book and
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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.