Spe­cial Re­port – Be­yond the bruis­ing

True Love - - Contents - By GLYNIS HORNING

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.

Re­silience comes with tak­ing care of your­self –tak­ing time to re­flect and­buil­dony­our ex­pe­ri­ences, so you can counter act some of the trauma, be­gin to heal

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