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Inscribed
Bodies: Health Impact of Childhood Sexual Abuse
by
Anna Luise Kirkengen, MD, PhD |
pdf >>
Review
by Vincent J Felitti, MD
Boston:
Kluwer Academic; 2001. ISBN: 0-792370198. 462 pages. $139.
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Although
sexual abuse is common in the lives of many childrena and
even decades later continues to show confusing sequelae in medical
practice, childhood sexual abuse is comfortably protected by social
taboo. The subject is therefore rarely acknowledged, much less included
in our "review of systems." In this book, however, we are
shown the profoundly destructive effects of familially and socially
imposed secrecy and of being unable to speak openly, even to physicians,
about childhood sexual abuse. Indeed, according to the author, "Violated
humans are made sick by the silence and are sacrificed to the
silence ... which societies still resist becoming knowledgeable of
and reflect[ing] upon." (page 390). Inscribed Bodies is
thus a book about things we wish not to know. This book, however,
has great value which far exceeds its (expensive) price. Such a profound
and insightful work as Inscribed Bodies comes into print only
once every decade or two.
The
author, Anna Luise Kirkengen, is a German physician in general practice
in Oslo, Norway. She describes her book as an examination of how patients
subjected to childhood sexual abuse had their integrity as humans
violated by this abuse. After exploring the adverse health effects
of sexual violation, Dr Kirkengen discusses the biomedical intervention
necessitated by this sexual violation. Unfortunately, this is not
a book about someone else's subspecialty.
Based
on tape-recorded interviews with ordinary patients seen by Dr Kirkengen,
the book provides readers with actual quotes from these conversations
as well as detailed analyses of them. The cases involve a wide range
of clinical presentations, including depression, suicidality, somatization
disorders, chronic pain, and chronic fatigue. Of course, most patients
come into
the office holding the necessary entry ticket of physical symptoms,
but this visit is really a disguised adaptive strategy for seeking
help (page 20).
The
book is divided into three major sections:
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Approaching life-world experiences;
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Unfolding the impact of sexual violation; and
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Exploring the medical making of patients.
A short
final section, Impressions, consists of a series of the author's
reflections expressed in the form of poetry.
Inscribed
Bodies deserves attention as the work of an unusually observant
and reflective physician who sees with frightening clarity and writes
with ease and elegance. Inscribed Bodies will be of great interest
to colleagues who feel an obligation to pursue self-development, both
professional and personal. The book will be appreciated by those who
are troubled by the disparity between the formal biomedical diagnoses
we learned so proudly and the actual human problems that patients
bring to us in our offices. The book will help us to accept the high
level of responsibility accorded physicians and to better understand
the human condition as we participate in the great dramatic moments
of other people's lives.
a A careful analysis of 18,000 middle-aged Kaiser Foundation
Health Plan members in San Diego showed that the prevalence of self-acknowledged
contact sexual abuse in childhood was 22%. The relation of this
childhood abuse to adult health status was profound.1
Reference
1.
Felitti VJ. The relationship between adverse childhood experiences
and adult health: turning gold into lead. Perm J 2002 Winter;6(1):44-7.
