With the Royal Commission into Family Violence (Victoria) handing down its findings and the report due to go public this week, we take a look at the search for solutions in two very different domains.
In our first piece, Monash University medical student Sarah Rockefeller advocates for improvements to the way sexual violence and women’s health is taught to future clinicians. Sarah presented her research at last year’s Population Health Congress in Hobart as one of the contenders for the John Snow scholarship.
Our second author, Pamela Nathan, a forensic and clinical psychologist with non-profit group CASSE, describes her work with Aboriginal men in Central Australia, and the cultural path to healing family violence.
Clinicians are in a unique position to identify and assist victims of sexual violence, but awareness must start at medical school, Sarah Rockefeller writes:
There is one pressing public health issue in Australia today, arguably the biggest public health problem, which makes many want to look away.
Despite growth in media coverage and acknowledgement of the violence against women epidemic in Australia, the healthcare industry continues to lag behind.
Sexual violence affects between 1 in 3 and 1 in 5 Australian women. Survivors of sexual violence experience many short and long term adverse health outcomes. This long list includes depression, anxiety, suicide as well as physical issues such as chronic pain syndromes and sexually transmitted infections.
Given this, one would assume that the health impacts of sexual violence and how to care for victims would be a core component of medical curriculums in Australia. However, research shows that this is not the case, and that in fact very few university medical courses cover this issue in sufficient depth if at all.
As a result, doctors in hospitals and the community are missing vital opportunities to assist survivors of sexual violence. This is despite the fact that research shows women affected by sexual violence are more likely to present to medical services with various health issues. Instead, their traumatic experiences are never discussed and thus the their health issues persist.
Last year I conducted a research thesis on sexual violence education for undergraduate medical students, by interviewing practicing doctors about their education on this topic and what they believed students needed to learn. All 44 doctors — both men and women — felt this was a crucial topic at the undergraduate level, as nearly all participants had experiences with survivors of sexual violence, particularly as junior doctors, and felt unprepared to provide best practice care.
Participants felt that the content should cover four key areas
- awareness and epidemiology
- health outcomes
- a trauma-sensitive model of history taking
- management and referral.
In addition, it was felt this material should be vertically and horizontally integrated into the curriculum using a mix of case-based tutorials and lecture/online materials.
Now that this research has been completed, I am working with academic staff to advocate for this topic to enter my own university medical curriculum, as well as medical schools more widely.
This process has made me aware of the difficulty of organising a curriculum in medicine, where there are seemingly unlimited things to learn about and everyone is advocating for their own specialty area to feature more heavily.
However, I think that in Australia we have reached a critical point where we are recognising this as an important public health issue and one which cannot be ignored.
I was fortunate to present my work as part of the John Snow scholarship at the Population Health Congress in Hobart and at the Sexual Violence Research Initiative (SVRI) in Capetown. It is heartening to see this issue get more public attention and to see the amazing initiatives being undertaken in this area globally. The SVRI forum is held every two years, where researchers and those with an interest in preventing sexual violence meet and present their work. With representatives from every continent and key global bodies, such as the World Health Organisation and the World Bank, it is clear this issue is not unique to Australia but is a global public health epidemic.
The medical profession needs to take the lead and play a much more active role in preventing sexual violence and assisting victims of violence. Doctors are in a unique position to connect with survivors and change their health outcomes for the better.
In Central Australia, eroded, suppressed and stolen cultural practices are providing new paths to healing the violent legacy of colonisation, writes Pamela Nathan:
Too many men remain dangerously quiet in the national conversation about domestic violence.
In the Northern Territory (NT) alone, 66% of assault victims are Aboriginal and 82% of these victims are women. When it comes to family violence, Aboriginal victims are ten times more likely to die as a result of an assault.
In the NT, Aboriginal and Torres Strait Islander peoples make up 86% of the adult prisoner population and 96.9% of young people in detention. Alice Springs, in recent years, was known as the stabbing capital of the world.
It’s easy to cast judgement and disfigure perpetrators with stereotypes. We can accuse them of being mad, bad and full of grog. Such a picture is an oversimplification and distorts the truth.
If we want to see real change, we need a new approach – as individuals caught in the violence, as organisations and governments responding to and dealing with the aftermath, and as clinicians involved in a therapeutic response.
We need to take a deeper look at the underlying issues.
Violence is about pain, suffering, humiliation, fear and trauma. Many perpetrators have a diagnosable but undiagnosed mental illness. Uncontrollable anger and violence can be an unconscious state of mind. Festering emotional trauma and pain can lead to irrational outbursts that are rarely planned and can result in incredible harm to and even death of a spouse or loved one.
There’s no doubt that uncovering the root causes of domestic violence is a matter of life and death.
In Central Australia violence can be equated with generational trauma; namely, the catastrophic interruption to and breakdown of cultural life and being.
The Aboriginal men on Arrernte country in Alice Springs, and the Pintupi and Luritja people in Ikuntji (Haasts Bluff), Watiyawanu (Mt Liebig), Walungurru (Kintore), Kiwirrkurra and Warumpi (Papunya), are taking on this issue with the help of CASSE (Creating A safe and Supportive Environment). We’re an organisation that applies a psychoanalytic approach to restoring mental health and wellbeing.
Busting systemic and cyclical violence requires recognition of the violence and the trauma experienced by both men and women.
Many violent situations are laced with doubt, despair, distrust, addiction, mental illness and negative thinking that can lead to destructive behaviour, including substance abuse and suicide, and even criminal behaviour such as homicide.
This is a psychological crisis. This crisis is the result of a broken and crushed identity which is not recognised.
When a person (or an entire culture) is not allowed to tell their story, acknowledge their trauma, speak their language, live their cultural way, there is an oppression that leads to a psychological death.
A while back I was at a town forum in Alice Springs held by CASSE, called ‘Walk in My Shoes’. Well-known Warlpiri elder Rex Granite from Yuendumu stood up during a Q&A session to comment. He said, “You don’t speak my language.”
He was saying so much more. He was pointing out that as English speaking descendants of colonists and migrants we don’t know his world, we don’t see him, we don’t recognise him. Despite belonging to the oldest continuous culture in the world, he has to speak our language and operate in our world.
Aboriginal men need their ancient laws, language and ceremonies recognised, and permission to make their traditional sacred objects like boomerangs and spears – without risking their confiscation like imprisoned inmates or naughty schoolchildren.
Aboriginal men need to be allowed to self-determine, continue and transform their cultural worlds.
The cultural and emotional violence of our colonial history and pervading racism cannot be overlooked (and it too often is). We need to look at this face on. Mutual recognition of past trauma and pain is needed.
For the Pintupi and Luritja men west of Alice Springs, there is a new project that is creating the space to be heard – the Tjilirra Men’s Movement. Tjilirra is the Pintupi word for traditional handmade tools.
To avoid the heat of the day, the men start at dawn finding and collecting wood. There is very little conversation. By late morning conversation will enter the group, sometimes singing, as they work at the wood, some teaching, others listening and together talking about what they are doing.
They learn the old ways to craft the wood “in memory of their ancestors”. The men speak their own language. The men “hold” the culture together.
By night – by campfire – animated stories, handling the spears and shields with song and ceremony, and serious conversation emerges. Each person is given the space to talk when they are ready. This is the consulting room of the bush, and it is where therapy (and transformations) happen. The past continues into the present, is examined and allows a new future to emerge.
No drugs and alcohol are consumed during a day of Tjilirra making. It is a facilitating environment where individuals can find a voice, and their pain can be recognised.
Healing can happen. Violence can stop. Recognition and shedding light on the hurting heart can create a path out but first we need to listen to the Aboriginal men in Central Australia.
We need to hear their language.