Updated: Mar 13, 2019
Sexual abuse, sexual violence, incest, rape: no matter how the violations are categorized and named, the reaction to them never goes away. I sat at my desk, in a hospital where I am the nurse director and heard this horrendous yelling and screaming coming from the patient care area. I went and saw this woman in the bathroom, kicking, spitting, hitting, and as I entered, a caregiver was leaving holding her arm, saying “she got me, she bit me, she needs more medicine”.
This woman had wet herself, as she no longer knew to go to the bathroom, she was terrified to sit on the toilet seat, she needed help to get cleaned to prevent sores, she believed she was being raped as she was nearly 60years ago. This woman was diagnosed with early onset Alzheimer’s, as the disease progressed, her brain shrunk, she was losing her ability to recognize what to do when she felt the urge to urinate, her visual spatial perception was altered and she unable to tell how low the toilet seat, was and convinced she’d fall. The area of her brain lost its reasoning ability, in her world she was being pushed down and sexually assaulted. So she fought with all her might. The more she fought, the more staff came to help, which meant physically restraining her, to prevent her from hurting herself and others. This senecio is probably the most difficult and challenging aspect of caring for patients with dementia.
The answer for preventing re-traumatizing is unclear, there’s no magic pill. Caregivers need to understand there are generations of “me too’s” who have dementia, who never spoke of their trauma, and who never received treatment. Yet, dementia with ones loss of reasoning, keeping events in context, differentiating events of the past from today, has a way of lifting the cover off past traumas.
So how do we prevent re-traumatization? We may not; in the context of providing necessary hygiene. However, the caregivers can help by understanding the realities of why a patient may be fighting during care, be aware of their own affect, tone of voice, and approach. Minimize the number of people in the room. Have patience, encourage the person to do their own care, if able; hand them the facecloth and softly tell them or demonstrate how to do the care.
Finally, talk to friends, family, clergy, professionals and get the support you need. To see a loved one or even acquaintance in this level of distress, for this reason, is extremely difficult.
Addendum Sexual violations are not unique to women. Boys and young men are victims, too. From my experience, healthcare providers frequently and easily question trauma when women have difficulties tolerating personal care or just being touched. For men, this isn’t the case. There needs to be increased awareness and acknowledgement that men’s aggressive behaviors may also be a result of childhood sexual abuse and deserves the same care and approach.