Page Utilities
Jean Langlois, ScD, MPH, Brain Injury Professional magazine (page 3 of 5) Page 3 of 5
Sexual abuse by a medical professional
It was the second [gynecological exam] in my whole life… [The doctor] dismissed the nurse and he told me to change into a paper gown and he didn’t leave the room....Yeah. And he made me put the thing so it opened in the front…, and then he came over and he pulled the paper open at my breast and everything and he was just looking and his looks were bedroom looks…., and then he took his hands and he started fondling my breasts. After [talking to me about sex and masturbation and touching my private area in a sexual way] … he put [the speculum] in hot and he said I can sterilize you if you ever tell anybody and besides you’ve got a brain injury. They’re not going to believe you.
Violence as a consequence of TBI
Aggressive behavior
According to Silver et al (2005), aggressive behavior after TBI includes explosive behavior that can be set off by minimal provocation and occur without warning. Episodes range in severity from irritability to outbursts that result in damage to property or assaults on others.
Reports of the incidence of aggression vary widely. Studies of patients with TBI conducted in medical outpatient settings typically report low rates of aggressive behavior (Kreutzer et al, 1999). In contrast, persons in a TBI neurobehavioral program displayed an average of about 280 aggressive acts per day during a 14-day period (Alderman et al, 2002). Sexual aggression was reported in 6.5% of a sample of male patients receiving either inpatient or outpatient TBI rehabilitation; the most common offenses were “touching” offenses followed by exhibitionism and overt sexual aggression (Simpson et al., 1999) Increasing evidence suggests that TBI-related aggressive behavior is strongly associated with depression (Kreutzer et al,1996; Tateno et al, 2003; Baguley et al, 2006).
Case examples
Paul was a new 16 year-old driver when he ran his car off the road and both he and his girlfriend sustained TBIs. After a 2 month coma and years of recovery, his social skills have not caught up with his age of 24. He was taken by police to the emergency room when a group of guys beat him severely and took his wallet. Surprised and humiliated, he responded, ”I don’t understand. I just asked them ‘do you want some of this.’ I guess they thought I wanted to fight because they just started beating me up.” Now four years later, despite his best intentions, he loses new friends when he throws things and screams obscenities at them. “They are looking at me and talking too loud” he says. “I said I’m sorry, I go too far before I know it.”
(Source: Cindi Johnson, Side-by-Side Clubhouse, Atlanta, GA, January, 2007).
After sustaining a brain injury in Iraq, Steve was diagnosed with post-traumatic stress disorder and depression. One of the effects of his brain injury is that he has a harder time keeping his emotions under control. He blurts out what he’s thinking or flashes his anger. Late one night driving his pickup truck, he and his wife, came to an intersection where he usually turned left. Now there was a ‘No left turn’ sign. Confused, he stopped and tried to figure out what to do. A policeman walked up. According to his wife “The cop, he shines the flashlight right in at Steve, and he’s screaming, ‘Can you not read, stupid?’ and he got irate. Steve said to his wife, ‘This guy just called me stupid.’ He let out the clutch on the truck and yelled at the cop. ‘I’ll show you stupid, because I’m not stupid. It just takes me longer to comprehend.’ ” He wanted to get out of the car then, but his wife told him “No, it’s not worth it.” She calmed him down and the couple drove on. In rehab, Steve is learning strategies to jog his memory and control his anger. He says “I bite my tongue so many times. I--they’ve taught me to really walk off, and it’s a hard thing for me to do, but I’m learning that.”
Adapted from National Public Radio report from November 29, 2005: http://www.npr.org/templates/story/story. php?storyId=5030571. Accessed 12/28/07
Reducing the toll of violence after TBI
Victimization
Screening for possible TBI among persons who have experienced intimate partner violence is critical to ensuring that those with TBI-related problems are diagnosed and receive needed services and/or accommodations. Professionals working in IPV prevention can benefit from information and training aimed at helping them identify and manage persons with TBI. Potentially useful methods for screening, identifying and assisting such cases have been proposed by both the Alabama Department of Rehabilitation Services and the Brain Injury Association of Virginia (See Interview with Maria Crowley, this issue, and sidebar of Intimate Partner [Domestic] Violence Resources). Additional research is needed to ensure that the screening methods for identifying TBI are both valid and reliable. The November-December 2007 issue of the Journal of Head Trauma Rehabilitation, which was devoted to articles about screening and identification of TBI, includes information about promising new screening methods.
Similarly, screening for victimization among persons with TBI is also important. Physicians are especially well-placed to conduct such screening. However, recent studies of the screening practices of physicians, including obstetrician–gynecologists, indicate that most conduct screening for violence only when warning signs are observed (Horan et al., 1998; Rodriguez et al., 1999).
Unfortunately, violence can exist in the absence of warning signs in the patient’s behavior or medical history. Women who are victims of violence may not present with symptoms, especially those who experience psychological or emotional abuse. They may conceal what they are experiencing at home. Because of the increased vulnerability of women with disabilities, including those with TBI, it is important to study the utility of screening these patients for IPV.
One of the most widely used screening tools is the Abuse Assessment Screen (McFarlane et al, 1992). This tool is short and has been tested in clinical settings. This and other tools for assessing IPV can be found in the Centers for Disease Control’s publication Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings. [See Intimate Partner (Domestic) Violence Resources sidebar, page 16.]
From Brain Injury Professional, the official publication of the North American Brain Injury Association, Vol.5, Issue 1. Copyright 2008. NABIS/HDI Publishers. Reprinted with permission. All rights reserved. www.hdipub.com. www.nabis.org.
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