Trusty old Wikipedia tells me that a sequela (usually used in the plural, sequelae) is a “pathological condition resulting from a disease, injury, therapy, or other trauma.” Basically, something medical and noticeable, an identifiable condition that happens as a consequence of something else.
I was prompted to find a definition after I read an article in the New Statesman by Dr Phil Whitaker. It was an article that I applauded and that also made me sigh. He tackled an important issue: many women who have been sexually abused or assaulted are often unable to undergo primary healthcare checks and screening that require intimate examinations.
He related the tragic story of Martha, a woman in her late thirties, who, despite suffering ongoing infections (which is why she presented for treatment), was unable to have an internal examination. She revealed to him that she had been sexually abused in childhood. The terrible outcome of this was that she had advanced cervical cancer and died shortly afterwards. A psychological sequela (painful in itself) and a physiological sequela (in this case terminal).
Dr Whitaker is so right to bring to light just one of the consequences of what we know thousands of children suffer, which continue throughout adulthood. And that is what I applaud. When I put my ‘outsider’ head on, and read the article from the perspective of someone who has not experienced or is not really in the know about the impact of sexual abuse, it raises awareness of something so important. The long term impact (and cost – human and fiscal) of abuse is complex, comes from all sorts of sources and is not always obvious. It makes you think.
As an ‘insider’ (someone who is a survivor of child sex abuse) there was something in the article that just made me sigh. I’ve written before about the casual use of labels and categorisations, which I find can mask the reality of what it’s like to live with the consequences of abuse. I do not have this criticism of Dr Whitaker’s article – it is sensitively written, insightful and avoids generalisations. But I still have a sense that I, as an abuse survivor, am being written about, without being able to identify with the description or the perspective.
So, I attribute a portion of my sigh to not wanting to be part of a ‘group’ defined by someone else, not me. Another portion of my sigh goes to that familiar, self-imposed distance: be outside it all, deal with it by not engaging with it, pretend, pretend, pretend. There’s a small portion of my sigh that comes from just wanting to be able to flick through a magazine or newspaper and not be confronted by the unwanted. But the final, most important portion is the horrible jolt of recognition. I know the psychological sequelae of my abuse mean I am taking risks with physical health:
I’ll hold my hands up and say that I’m 44 and I’ve had one smear test in 20 odd years. This is bad. One doctor said to me “it’s the best insurance policy you can have”. Yes, of course – and I’d gladly do it if it meant filling out a form and paying an annual premium. Another GP, to whom I disclosed my childhood experiences, listened and offered (unprompted by me) to stop the smear reminders. I understand her motivation but it isn’t the answer.
I’ll also tell you that my trips to the dentist are infrequent-to-nonexistent – I’m waiting for the toothache that will force me to go. It will be a terrifying relief, as only that physical pain crisis will get me in the chair to have a stranger make me hold my mouth open and put things in it. To tell them I’m a nervous patient underplays it somewhat.
And several weeks ago I managed to get myself to the optician. Another basic health check that I have avoided…for nine years. Recently I fell over several times in quick succession simply because I could no longer see properly; the prescription in my glasses was too old to be useful. But sitting in the chair, in the dark, in a small room, unable to move, with a stranger at such close proximity is very, very hard. Of course I survived to see another day, but I didn’t relish it.
Some days the ramifications of abuse can feel overwhelming – a chain of “sequelae” not just one or two. Martha’s story is a stark reminder that sometimes it is really bad. But amongst all this I found a chink of light: mybodybackproject.com. This project gives a bit of hope to people like me (and countless others out there) who at the moment can’t access simple checks that might save our lives.