Iatrogenic

I love this word. It is very handy in scrabble.  I goggled it and found that one can make 27 2-letter words, 92 three-letter words, 138  4-letter words, 125 5-letter works, 82 six letter words, 35, 7 letter words and 12 8-letter words just from the letters found in this one word.

I know that you are especially interested in the 8 letter words.  They are actioner, anoretic, bacterin, baritone, boracite, bornitic, creation, obtainer, rabietic, reaction, reobain, and taborine (Merriam-Webster.com/scrabble/finder). Who knew this scrabble aid was even available?

The British Dictionary defines Iatrogenic as:

1.   medicine (of an illness or symptoms) induced in a patient as the result of a physicians words or action, esp as a consequence of taking a drug prescribed by a physician.

2.   Social welfare (of a problem) induced by the means of treating a problem but ascribed to the continuing natural development of the problem being treated.

The word itself is derived from the Greek work latros which means physician and the English word genic

If we continue on this search for meaning we will find physician is the Greek word for healer.  Thus, although frequently used to refer to medical doctors, it can also be applied to anyone who is a practitioner of the art of healing.  One can, and we often do, speak of the healing of a person, a family, a community, a nation, or portion or area of the earth. It could conceivably be used to describe what is caused the collateral damage when dropping bombs. This usually refers to the killing of so called innocent people.

Those of us who are overtly identified as health care providers like to think of ourselves as healers and, yet, we often prescribe treatments, including medications (for those who can legally prescribe medications) which have very negative side affects.  Often other medications are then prescribed to counter the side affects of the initial treatment.

We can also use the term to refer to the “dis eases” which are a direct result of the treatment we provides as counselors, psychiatrists, therapists and what are commonly called victim advocates.

I know, as a licensed counselor who has practiced for many years,  that my intention and my commitment is to do all I can to help people heal.  I am sad to say, however, that many of us have, unwittingly, contributed to the long term “dis ease” of our clients/patients by labeling them as victims and, at times, testifying in court that these “victims” have been “damaged for life”. More than once I have sat in a courtroom and heard this term used by many of my colleagues. Sometimes I have testified that, for whatever, reason, someone was unable to move beyond the trauma and return to work.  Seldom can I give a reason or an explanation for why this is so, but I know the reason is not just the traumatic event being then considered.

Nowhere is this dynamic more prevalent than the person who is the recipient of unwanted/uninvited  or inappropriate sexual contact.  Certainly in the case of a small child or someone who is emotionally or mentally challenged there was not an informed consent to engage in sexual contact.  In other cases, there may have been informed consent, but, we, as a community, have decided that the power differential was such that it is difficult, at best, to establish informed consent.   Sometimes, it is the case of someone such as Josh Drugger, the reality television star, “inappropriately touching, through clothes, younger siblings and a younger baby sitter”.     This case has been discussed a lot in recent media.  Perhaps it is so widely discussed because the family is so well known or perhaps because they have apparently sometimes been presented as the paragon of virtue - representative of a conservative Christians.   I have never actually seen them on television.   Apparently Josh, now age 27, was a lobbyist for the Family Research Council which is often touted as a conservative Christian group.  Since these incidents happened in 2002 and 2003 and police were not alerted/tipped until 2006,  in the sate in which these incidents occurred, the statue of limitations had expired.  Thus, no charges were filed.

Michelle Dugger, the mother, is reported in an article by David Bauder published in the Tampa Tribune on June 5, 2015, page 2, to have said of her daughters:

“have been victimized more by what has happened in the last couple of weeks then they were 12 years ago because honestly, they didn’t even understand and know that anything had happened until after the fact when they were told about it.” 

We know that at least one of those  affected, his sister, Jessica told a Fox news interviewer that her brother is not a child molester or a pedophile.  She is very supportive of him.

So, what are the facts here:

·      Josh has admitted to inappropriately sexually touching his sister and the babysitter when he was a teenager (14 and 15)

·      One of the children may have been as young as five.

·      It is possible that the individuals affected have some residual feelings which could affect current relationships. Being more consciously aware of and the past actions and feelings associated with those actions could facilitate some healing.  Such sexual contact can result in shame and other feelings if not talked about with a supportive person.

·      Given the family history, it is entirely possible that Josh and his siblings did not talk to anyone about strong sexual feelings or what to do with them.

·      It is very possible that at ages 14 and 15 Josh could have had very strong and very frustrating sexual feelings but would not have felt okay about masturbating and certainly not okay about seeking out same age sexual partners.

·      It appears that Josh is genuinely sorry for his behavior.

·      Sexual contact that does not physically injure or make the individual feel like an object to be used does not necessarily result in the person feeling traumatized.

·      The definition of trauma is often shaped by the culture in which one lives although some experiences would be clearly experienced as trauma in almost any culture.

·      Labeling the girls as victims may make them eligible for certain services but does not otherwise facilitate any healing they need to do.

·      What used to be called playing doctor or nurse by siblings (close to same age) is now often labels as sexual abuse.

·      Sexual contact feels good if and only if it  is within a loving, respectful relationship. Even when it is unwanted it does not necessarily result in being experienced as a trauma.  For example I have been to court where a immature 19 year old was convicted of statutory rape of a very willing 15 year old who thoroughly enjoyed the contact until his mother found out and shamed him.   The advocates and therapist testified that this 15 year old had been damaged for life.  I basically said that the 15 year-old  enjoyed oral sex. He did not enjoy being shamed by his mother and, of course, then blamed the 19 year old for forcing him.  The 15 year old had made videos which clearly showed a willing participant, but these videos where not admissible in court.

·      Power differential should never be used except to protect the safety of an individual. For example, grabbing someone, child or adult, who is about to run into traffic, is  a good thing. Using power differential to cajole a person into sexual activity is never okay in my value system although in many cultures and until recently in the US Culture forcing a 12 or 13 year old to get married  was and is perfectly acceptable.

As health care providers, social workers, and advocates we need to be very careful to  do the following:

·      Determine the level of trauma, if any, involved.

·      Do not impose the term victim on a person.

·      Assure the person that they can heal no mater how severe the trauma.  Even though who have been tortured as prisoners of war can heal.  Just because one has scars does not imply that one is incapable of healing.

·      Make sure the helper does not bring one’s own history or agenda to the person one is treating/helping.

·      Validate the trauma without cosigning victim status.

·      Do not confuse inappropriate shame with trauma.

·      Do not fall into the trap of  using an inappropriate diagnosis just because that is the only way to get insurance to pay for needed counseling. 

·      Distinguish between mental illness, acute trauma reactions and  handling normal life events.

·      If one does do something in the course of treatment which results in new symptoms then take responsibility, make appropriate amends and make sure treatment options for new symptoms are addressed.

Some iatrogenic “dis ease” is unavoidable.  The benefits of some medication I take far outweigh the nuisance side affects. Still, it is helpful for the doctors to validate the fact of the side affects. Too often, in my experience the doctor has insisted that medication or other treatment could not have caused the new symptoms when it is clearly the case that they did.  I call that “crazy making”  and is not acceptable.   My experience is also that counselors/therapists are also reluctant to admit that their treatment caused new symptoms.  We must  quit allowing the fear of lawsuits or the fear of being labeled as a poor therapist on social media to make our decisions. Decisions made on the basis of fear may be understandable but they seldom benefit anyone.

As soon as we begin to address any area of sexuality including possible sexual abuse we treat it differently than we often do other aspects of our humanness.   It is, of course, a very intimate part of us. On the other hand, it is also a very powerful and natural part of being human.  It would be enormously helpful if we quit treating sexual issues, including abuse, as something different than other issues or other forms of abuse.  For example, having someone invade my space is not acceptable whether or not my genitals are involved in the invasion.  I would like some support in protecting my space but I do not want to allow the invasion to have a significant negative impact on the rest of my life journey. I do want to be able to say very clearly to  others that they may not invade my space. If they continue to do so I may need some support, even legal support at times, but I do not need to sue for millions of dollars in damages!