Special Report – Beyond the bruising
If you are one of South Africa’s many victims of abuse, new science suggests you have a higher risk of a host of long-term health problems, from heart disease to depression, and a shorter life span. Understanding this can encourage you to address abuse early and take steps to heal.
When you go for a medical check-up, health professionals measure your cholesterol and blood glucose levels and ask about diet and exercise. But most don’t ask a key question that could make a significant difference to your health and how long you live: “Have you ever been abused, especially when young?”
It’s now emerging that the effects of abuse go far beyond broken bones and bruising. Yet in our country, where one in five women experience physical violence, and one in 17 suffer sexual violence by a partner (Statistics SA), discussions of gender violence still centre on the immediate crisis. To date, there’s been little focus on its long-term legacy.
“We’re understanding more and more that if you experience violence, you’re at a higher risk for some of the largest health problems, including heart disease, chronic pain, asthma and arthritis,” reports Lisa James, director of health at Futures Without Violence in the US.
South African experts confirm this. “Along with all the ‘expected’ psychological effects of abuse – isolation, lack of trust, feelings of nonself-worth, trauma and fear – there is a definite physical correlation that affects things like heart disease, blood pressure, muscle tension and stomach issues,” says Janine Shamos, a counsellor with the South African Depression and Anxiety Group (Sadag). “Many women I work with have to deal with physical issues like chronic irritable bowel syndrome, sleep disturbances, high blood pressure, anxiety and depression.”
Clinical psychologist Leonard Carr adds: “The damaging long-term effects of abuse affect every part of a person’s life, from their relationship with themselves, with others and with life itself.”
THE STRESS EFFECT
As Leandie Buys, a relationship therapist and
clinical sexologist in Port Elizabeth, explains: “In a stressful environment where there is fear and anxiety, a person’s body will go into a survival mode of fight or flight, or freeze. If they are unable to express their emotions they internalise them, which means they will be in constant survival mode, where the body will release the stress hormone cortisol. Cortisol is like an acid in the body and can cause long-term effects like gut problems.”
By altering the levels of hormones in your body, stress can affect your immune system, contributing to health problems from high blood pressure and heart disease to obesity and diabetes. And unless you address the underlying abuse with counselling and therapy, you also remain at risk years later for mental health issues, such as anxiety and post-traumatic stress disorder.
A history of severe physical or sexual abuse is associated with a 90% increase in addictive eating behaviour as a “self-comforting coping mechanism”, notes a Harvard study, and other research suggests you are up to 15 times more likely to self-medicate with alcohol, and nine times more likely to escape in drugs.
If you are abused from a young age, the effects can be even worse. The major US Adverse Childhood Experiences Study, following participants’ health over 20 years, suggests abuse in childhood contributes to chronic diseases (heart disease, cancer and stroke) that are among the most common causes of death and disability – and six or more experiences of abuse as a child can cut adult life expectancy by 20 years. Research findings suggest childhood abuse can actually change the structural development of neural networks and your brain, including the brain’s pleasure and reward centre, linked to substance dependence, and the prefrontal cortex, linked to impulse control and learning. It can also affect the biochemistry of the neuro-endocrine system (which regulates things like reproduction, metabolism, and eating and drinking behaviour), affecting immunity and accelerating the progress of disease and ageing.
The stress of childhood abuse may actually change your DNA. According to researchers at the University of Wisconsin-Madison in the US, early traumatic experiences can alter DNA methylation, a chemical code that helps control when genes are activated. “Adult survivors of childhood abuse will have long-term health effects,” Buys explains. “As one researcher has put it, ‘The body keeps score’.”
STEPS TO HEALING
The first step to addressing the long-term effects of abuse is to acknowledge it. Often it lies buried, coming to light only when related health or relationship problems become impossible to ignore, and you seek help for those. “I see this when couples present for relationship concerns – it’s only when I start looking at their past that they start understanding why they find it hard to function in a healthy way. They find it difficult to trust and to bond, and in situations where they fear hurt, they can easily detach themselves from the situation – that is how the child has survived abuse,” Buys adds. Substance abuse and disordered eating are often signs of severe trauma, says Durban psychologist Dr Akashni Maharaj. “It’s not uncommon for individuals who’ve not dealt with abuse to develop chronic symptoms and dependency later in life.” You need to work through abuse with therapists trained in trauma, find ways to manage the pain and anger, develop coping mechanisms, and start rebuilding your self-esteem. Resilience comes with taking care of yourself – taking time to reflect and build on your experiences, so you can counteract some of the trauma, begin to heal, and have the strength to address abuse-related health and other problems, Buys continues.
WAYS THAT WORK
1. Read up about trauma. “You need to understand its long-term impact,” Buys says. Write it down. It’s cathartic as a means of releasing emotions. 2. Confide in someone you trust, in a safe environment. A professional counsellor is generally best, as you need someone
non-judgemental, who will not react with shock or tell you to move on. 3. Join a support group. You can keep retelling your story in safety when friends and family have wearied of it. 4. “Abuse in general disconnects you from your body, mind and spiritual self,” Maharaj says. “Yoga or body therapy ( body talk) can help your body release pent-up anger and energy, restore balance to an injured body, and help you reconnect with your physical and spiritual self.” Try meditation. Done daily, it helps you reconnect yourself and aligns you with a higher purpose. 5. Get in touch with nature. “It’s a great way to find yourself and assists in the healing process.’” 6. Constantly remind yourself it’s not your fault. Lots of self-blame goes with abuse. 7. Become your own best friend. “Cultivate self-care and self-compassion,” Carr urges. “Make yourself the beneficiary of whatever goodness you offer to others.” 8. Call: POWA 011 642 4345, LifeLine 0861 322 322, Famsa 031 202 8987, Family Life Centre 011 788 4784, SADAG 0800 21 22 23
new husband doing this. From when I was 11 he’d rape me twice a month. I told my teachers and a school counsellor, but my mom convinced them I was lying because I hated my stepdad. They thought I was trying to justify my bad behaviour – I was always acting out. I began cutting myself and threatening suicide for attention, but got no support. As soon as I finished my studies I left home. Five years ago I laid a charge with the police against my stepdad, but my family and teachers still denied everything to protect themselves, so the cops declined to prosecute. The long-term effects: I can’t handle men. I’ve married a wonderful woman who puts up with the results of my abuse: chronic insomnia from lying awake listening for the door handle as a kid, depression and anger – I lash out easily. I’ve been diagnosed as bipolar and have temporal lobe epilepsy, blacking out for short spells under stress. I was told early abuse transforms the brain – it develops slower and neurons fire differently, probably causing my bipolar disorder. The healing: I’m on a truckload of meds. But best was studying film-making. Now I’m transforming my experience into a #MeToo documentary, exploring victims’ and perpetrators’ stories and the physical and emotional ramifications. I’ve launched a crowd-funding campaign: www.thundafund. com/project/metoo; www.victoraspictures.com.
FIKSO SIMAYE, 36, training provider The abuse: It began at school, but I didn’t see it as abuse – I thought it was just what happens in a relationship. He was six years older than me, confident, mature, and spoilt me with nice things my mom couldn’t afford as a domestic worker. He also had a temper and was jealous and controlling. We fought all the time and sometimes he’d hit me. He chose the friends I’d hang out with, and fetched and dropped me to be sure I saw no one else. But I thought it was love – I couldn’t discuss love with my mom in our culture. When I was 19 and got pregnant, I had to marry him – it was expected. But the abuse got worse. He’d put me down in front of the kids to turn them against me. Then a few years ago he went away for business for six months, and my sister helped me do some short business courses. I suddenly saw I could live on my own and be independent – I wasn’t useless like he’d tell me. It wasn’t easy, but I left him. The long-term effects: I’d punish myself by not eating for days, and got very thin. I still battle around food and self-esteem. I feel suicidal at times. The healing: Counselling has helped a lot, and going back to school and starting my own business. I’ve discovered who I am, my purpose, my destiny. I’m learning to be happy with who I am.
KATLEGO ORATILWE, 34, education student The abuse: I was just 19, he was this good-looking actor with a big personality. I knew he hit his previous girlfriend, but I thought she must have done something wrong – it would never happen to me. The first time he hit me, he swore it would never happen again. Of course, it did. When I wanted to leave, he’d say, “Who would have a fat girl like you?” Then I had a baby, and he’d say, “Who would have a fat girl with stretch marks?” I believed him. When the baby died he didn’t even come to the funeral. Then he got into crystal meth, and when I didn’t make enough waiting tables, he’d beat me. He’d use a horsewhip and step on my head until I passed out. Last year he held a knife at my throat and I saw death in his eyes. That night I called my mom to send money. I left everything in the flat, even my laptop, and went home to the Free State. My uncles sent word that if he ever set foot there, he would regret it. The long-term effects: I have painful ulcers, depression and paranoia. The healing: Therapy has helped, and antidepressants, and meeting a patient, gentle man. On my therapist’s advice, he bought me a puppy, a German shepherd/pitbull mix – walking Mammy is therapeutic, I feel safe with her and with this man. Now I’m doing a postgraduate certificate in education to teach drama and English, so I can help other young women not fall into the same trap I did. I have a mission and it helps me feel strong.
LILY PETERS, 32, market analyst The abuse: I was an over-achieving goody two-shoes, the girl others turned to for help, but I was lonely. By second year varsity, it wasn’t working for me – all my friends were going partying and seemed happy. So I began going out with them. One of their friends took an interest in me, he was tall, sexy. He began asking when we’d progress to the next level. I was a virgin and told him, and he seemed fine with it. Then one night I was out with him and his friends, and after a few drinks I began to feel strange: light-headed, weak, sleepy. When I tried to stand, I fell to the floor. To my relief, he offered to take me out to his car for some air. Last thing I remember was trying to hold on to him while he carried me. I woke next morning in a bedroom I’d never seen. I felt pain between my legs and realised I was naked from the waist down. When he walked in with a towel around his waist, fresh from the shower, all I could do was stare at him. I couldn’t even cry. All I remember is him telling me he knew I’d “wanted it from the start”. I told my mom I was date-raped and was given emergency contraception and put on a month’s antiretrovirals. The long-term trauma: I struggle to trust any man, and to see my body as a temple – I went on to have a number of sexual partners in a short period. One introduced me to recreational drugs, and I got pregnant and miscarried. He cheated on me and I sank into an ever deeper depression. The healing: I went to rehab, where I learned invaluable tools. Writing down my thoughts and keeping fit lifts the spirits and brings balance to my life. But the main thing is simply taking one day at a time.