Chapter 22: Sexual Violence

Welcome back to the Deep Dive.

I'm your host, and today we are opening a door that frankly a lot of people try to keep shut.

Yeah.

We are diving into chapter 22 of Essentials of Psychiatric Mental Health Nursing.

And the title of the chapter is simply Sexual Violence.

It is, it's a heavy door to open.

There's really no getting around that.

But for the nursing students listening, or honestly anyone who cares about how we treat trauma in this country, this chapter is completely non -negotiable.

Right.

It is one of those topics where the medical, the legal, and the psychological,

they all just crash into each other right in the emergency room.

And usually, you know, when we talk about medical stuff, we're talking about viruses or broken bones.

Right, biology.

Yeah, things that are accidental or biological.

But this is different.

This is about violence.

This is about a crime.

And the nurse is standing right in the absolute middle of it.

And that is the unique position of the psychiatric mental health nurse here.

You aren't just treating a patient.

You're potentially preserving a crime scene.

But that crime scene is a human being who is scared, hurt,

and probably experiencing the worst day of their entire life.

So our mission for this deep dive isn't just to recite a bunch of statistics.

We really wanna walk you through the nursing process.

Exactly.

The whole thing, right?

Assessment, diagnosis, planning, implementation, and evaluation.

Specifically for this patient population, we need to understand the communication approach that the text really emphasizes.

Because saying the wrong thing in this scenario, I mean, it can do as much damage as the assault itself.

So let's start where the chapter starts.

We need to get our definitions straight.

The text uses sexual violence or SV as the big umbrella term.

But think of SV as the broad category.

It includes everything from sexual harassment to completed rape.

It covers date rape, acquaintance rape, gang rape, incest, statutory rape.

It is the wide net of non -consensual sexual acts.

But inside that umbrella, we have the specific legal term, which is rape.

And the text points out something I found really surprising, or maybe just disappointing regarding the timeline.

The US Department of Justice didn't update their definition of rape to be comprehensive until 2012.

It is shocking, isn't it?

Yeah.

Before 2012, the definition was incredibly narrow.

It largely focused on the forcible rape of women.

The 2012 update was a watershed moment because it finally became gender inclusive.

Which means what exactly for the clinical setting?

It means the law finally caught up to reality.

It recognized that the victim can be any gender and the perpetrator can be any gender.

It stopped being defined as a quote unquote woman's issue in the eyes of the DOJ and just became a human issue.

And the mechanics of the definition changed too, right?

It got very specific.

Very specific.

The new definition highlights that penetration, no matter how slight of the vagina or anus with any body part or object or oral penetration by a sex organ constitutes rape if it is without consent.

That phrase, no matter how slight, seems legally really significant.

It is.

It removes all the ambiguity.

But the biggest pillar of this definition is without consent.

And I think this is where a lot of public confusion still exists.

Oh, absolutely.

The text is very clear.

Consent isn't just about someone saying the word no.

Right, because if you can't speak, you can't say no.

Exactly.

The definition includes situations where a victim is strictly unable to consent.

Maybe they're too young.

Maybe they have an illness.

Or, as is very common, maybe they are under the influence of drugs or alcohol.

If you are intoxicated to the point where you cannot make a rational decision,

you cannot consent, period.

And what about fear?

I mean, if someone holds a weapon to you or threatens your kids and you just don't fight back?

That is not consent.

Silence caused by physical threat is not permission.

The text is totally adamant about this.

And this leads us to what is probably the most important conceptual framework in the entire chapter.

We have to debunk the myth of desire.

This is the power versus sex debate.

Well, it shouldn't be a debate.

The clinical and psychological consensus is crystal clear here.

Sexual assault is an act of violence, power, and hate.

It is not about sexual satisfaction.

I think that's hard for some people to wrap their heads around because the act itself is sexual.

The tool is sexual.

The weapon is sexual.

But the intent is dominance.

It is committed often in a context of unequal power to demonstrate control.

It's designed to humiliate and degrade the victim.

If you view it through the lens of uncontrollable lust,

you will mistreat the patient.

You have to view it through the lens of assault and battery.

Precisely.

And that mindset shifts everything.

How you talk to them, how you touch them, how you advocate for them.

Okay, let's move into the numbers.

Section one of the text covers prevalence and populations.

Who is this actually happening to?

And I get the sense from reading the chapter that whatever numbers we cite here, we are probably wrong.

We are almost certainly under -counting.

The text calls this out immediately.

Sexual violence is one of the most under -reported crimes in the entire world.

The estimate is that only about one in three sexual assaults is actually reported to authorities.

So if we see a statistic, we need to mentally multiply it.

You have to assume the reality is significantly higher.

But even the reported numbers are staggering.

Let's look at college -age women.

The text calls this the red zone.

Yes, specifically the first and second years of college.

You have young women, often away from home for the first time, navigating new social hierarchies, maybe experimenting with alcohol.

The statistics show that one in five college women is likely to file a report.

Wow.

But estimates suggest 20 to 25 % will experience an attempted or completed rape during their college career.

That is one in four?

That's a quarter of the female population on a campus.

It is an absolute epidemic.

And it's not just strangers jumping out of bushes.

It's happening in dorms at parties by people they already know.

Now because of that 2012 definition change we mentioned, we are finally talking about men.

And this is a group that I feel gets erased from this conversation constantly.

You're right, and the erasure is really dangerous.

The text notes that one in six boys are abused before the age of 18.

That is a massive number.

But for adult men, the barrier to reporting is what we call the stigma wall.

The stigma wall.

Men who are raped often face a culture that questions their masculinity.

People ask, why didn't you fight them off?

Or they assume the victim must be gay.

The shame is compounded by these rigid gender expectations.

And there's a biological factor mentioned in the text regarding men that I hadn't really considered before, the HIV risk.

This is a grim medical reality.

Male survivors actually have a higher risk of HIV infection compared to female victims.

Why is that?

This is because the physical trauma of anal tears during the assault facilitates the transmission of the virus directly into the bloodstream.

So a male victim isn't just dealing with the psychological trauma of the assault.

He's facing a heightened life or death medical crisis immediately.

Correct.

And statistically, male survivors have a higher risk of suicide.

We also have to acknowledge where this is happening.

Male on male rape is vastly under -reported in prisons and the military.

These are hyper -masculine environments where reporting victimization can put a literal target on your back.

We also need to talk about the LGBTQ plus community.

The text highlights that this group is incredibly vulnerable.

Vulnerable to what we call dual layer trauma.

Over 50 % of gay men and lesbians report coercion by a partner.

But on top of that, sexual assault in this community can also be a hate crime.

And the barrier to reporting there.

Fear of homophobia.

Imagine being assaulted and knowing that if you go to the police or the hospital,

you might have to out yourself to people who might be prejudiced against you.

You might fear being re -victimized by the system that is supposed to help you.

It's a paralyzing dilemma.

And then we have children.

This is the part of the chapter that just makes you want to close the book.

It is completely heartbreaking.

One in nine girls,

one in 53 boys.

But the statistic that hurts the absolute most is the perpetrator profile.

In 93 % of cases involving children, the perpetrator is someone the child already knows.

93%.

Often a parent,

a relative, or a trusted authority figure.

This destroys the child's fundamental understanding of safety and love.

And it sets up a terrible cycle.

The text notes that people sexually assaulted as children are four to five times more likely to be assaulted later in life.

Because their boundaries were erased before they could even form them.

Exactly, they're basically conditioned to comply.

One last group the text mentions, and I think we often forget them, is older adults.

We do forget them, but predators don't.

Vulnerability increases with age, especially with cognitive or functional impairment.

Like dementia or mobility issues.

Right.

If you need help bathing or dressing, you are in a position of total dependency.

The perpetrators here are often adult children or caregivers.

It is the ultimate abuse of power over the helpless.

So we have a really clear picture of who is at risk.

Basically everyone, but with specific vulnerabilities.

What about the perpetrator?

Is there a clinical profile?

There is, but we have to be careful with it.

The text warns against the normalcy myth.

Sexual violence happens in every tax bracket, every neighborhood, every single race.

You cannot look at a person's zip code and know if they are safe.

But psychologically speaking.

Psychologically there are trends.

The text notes a high incidence of antisocial personality disorder.

These are individuals who lack empathy, who view other people as objects to be used for their own gratification.

They tend to be impulsive and often hostile toward women.

And often they have a history of violence themselves.

Yes, a history of childhood abuse or witnessing domestic violence is common.

It doesn't excuse the behavior of course.

Plenty of abuse survivors never become perpetrators.

But provides context for the cycle of violence.

They are seeking that feeling of dominance to counter their own deep feelings of powerlessness.

Okay, we've set the stage.

We understand the scope.

Now let's get to the core mission of this deep dive.

The nursing process.

Let's imagine a survivor has just walked through the doors of the emergency department.

What happens first?

Priority number one is safety and triage.

A sexual assault victim is an immediate priority.

You do not hand them a clipboard and tell them to take a seat in the waiting room.

Why not?

I mean, aside from the obvious distress.

Because they are in a crisis state.

They might be terrified.

The attacker is still nearby.

They might be suicidal.

The text is totally emphatic here.

The staff should provide a private room immediately.

And crucially, the victim should never be left alone.

Never be left alone.

That's a heavy resource requirement for a busy ER.

It is, but it's absolutely necessary.

They need a sitter or a nurse present constantly.

Being left alone in a sterile clinical room after a violation like that can trigger massive anxiety or severe dissociation.

This is where we get introduced to the specialized cavalry.

SART and CENE.

SART stands for sexual assault response team.

This is the multidisciplinary approach.

You've got police advocates, prosecutors, and nurses all working together.

But the star of the show, for our purposes, is the CNEs.

Right, S -A -N -E, sexual assault nurse examiner.

I have to admit, before reading this chapter, I just assumed any R nurse could do a rape kit.

I didn't realize it required a whole separate certification.

Why can't a regular RN just do the swabs?

They can, technically, in a pinch.

But a CNE is a certified forensic nurse.

They're especially trained in the exact intersection of medicine and law.

If a regular RN takes a swab but drops it on the counter or puts it in a plastic bag instead of a paper envelope, that evidence might completely degrade.

Plastic versus paper really matters that much.

It makes a huge difference.

Plastic traps moisture.

Moisture creates mold.

Mold destroys DNA.

If that DNA is ruined, the evidence is gone, and the rapist might just walk free.

SANE knows this.

They know how to maintain the chain of custody.

The chain of custody?

Yes, proving that the evidence went directly from the victim to the lab without ever being tampered with or contaminated.

So the SANE is essentially a detective with a stethoscope.

That is a perfect way to put it.

They also provide expert testimony in court.

They know exactly how to document injuries so that a jury can understand them later.

Let's talk about that documentation.

The text has a whole section called the interview and documentation where it outlines the communication approach.

It lists specific words to use and words to avoid.

It honestly felt like learning a new language.

It is a legal language.

The nurse has to be entirely objective.

For example, you never write, quote, the patient was raped.

Why not?

If they say they were.

Because rape is a legal conclusion.

A judge or a jury decides if it was rape.

A nurse documents what the patient says.

So instead you write, quote, the patient reported sexual assault.

Okay, so reported instead of alleged.

I noticed the text absolutely hates the word alleged.

Alleged is a defense attorney's word.

It implies doubt.

It implies skepticism.

Reported is a neutral factual statement.

The patient reported X.

It validates the patient's voice without overstepping the nurse's clinical role.

Here's another pair I noted, declined versus refused.

This is all about power.

Writing the patient refused the pelvic exam makes the patient sound difficult, non -compliant, or like they have something to hide.

But writing the patient declined the pelvic exam sounds like a person exercising their basic patient rights.

It respects their agency.

And penetration versus intercourse.

Intercourse implies a mutual consensual act between two people.

Penetration is a clinical descriptive term that fits the context of violence.

We do not use romantic words for violent crimes.

The one that really stuck with me though was the warning to avoid the phrase no acute distress.

That's a standard chart phrase, right?

Patient is sitting up alert, no acute distress.

It is very standard.

And in this context, it is incredibly dangerous.

A nurse might look at a rape survivor who is sitting quietly on the bed staring at the wall, not crying.

And the nurse just writes no acute distress.

Because they aren't screaming.

Right.

But that silence, that could be severe dissociation.

That could be a freeze response.

They are in extreme distress.

It just doesn't look like hysteria.

If a defense lawyer sees no acute distress in the chart, they will tear that victim apart in court.

They'll say, see, she was fine.

So what should the nurse write instead to be accurate?

Describe the specific behavior.

Patient is quiet, avoiding eye contact, hands trembling flat effect.

You have to paint the actual picture of the trauma.

Now before the physical exam even starts, the nurse has to give the patient some instructions.

And honestly, reading these instructions, they sound like pure torture.

The don'ts, yes.

This is often the hardest part of the initial interaction.

The patient wants to get clean.

They feel dirty, they feel violated.

Their immediate instinct is to shower, scrub, brush their teeth, burn their clothes.

And the nurse has to say stop.

Do not shower, do not bathe, do not wash your hands, do not wash your face, do not brush your teeth, do not change your clothes.

You are literally asking them to sit in the filth of the assault.

We are asking them to preserve the DNA,

the saliva, the semen, the skin cells under the fingernails.

It is a horrific thing to ask of a traumatized person, but is the only way to catch the perpetrator.

Does the patient have the right to just say, no way I'm showering?

Absolutely.

Patient rights are always paramount.

They can refuse, they can decline the evidence collection.

But the nurse's job is to inform them.

If you wash,

the evidence is gone forever.

If you let us collect it now, we can store it.

You don't have to talk to the police today.

We can just keep the kit safe in case you change your mind later.

That's a really crucial option, the blind reporting or the anonymous kit.

It preserves their future choices without forcing them into a legal battle immediately.

Exactly.

It gives them back a tiny piece of control.

Let's visualize the physical assessment itself.

The text mentions using a body map.

It's a literal diagram of a body, front and back.

The nurse examines every inch of the patient, every bruise, every scratch, every single bite mark.

They draw it on the map, they measure it, they photograph it.

It sounds incredibly invasive.

It is.

That's exactly why the Senni nurse is trained to go slow to explain every single touch.

Look at your arm now, is that okay?

It's about giving control back to the patient during an exam that unfortunately mimics the vulnerability of the assault.

And the specimen collection?

Well, the rape kit, what's in it?

It's very extensive.

Fingernail scrapings because the victim might have scratched the attacker in self -defense.

Pubic hair comings, swabs from the vagina and the anus in the mouth.

And the clothing itself is crucial evidence.

Often the nurse has to take the patient's underwear and clothes and put them in paper bags.

Leaving the patient with nothing.

Usually hospitals have a sweat suit or scrubs to give them, but essentially, yes, it is a process of stripping everything away to find the truth.

There's also mention of a chemical assessment, taking urine samples.

This is specifically if a date rape drug is suspected.

But time is the real enemy here.

Those drugs metabolize incredibly fast in the body.

If the victim waits 24 hours to come to the ED,

the drugs might be completely gone from their system.

The urine sample needs to be taken immediately.

We'll dive into those specific drugs in a minute, but first let's move to the next step in the nursing process, which is diagnosis.

The text identifies a specific syndrome associated with this trauma.

It's called rape trauma syndrome.

It is a specific nursing diagnosis, and essentially it is a variant of post -traumatic stress disorder or PTSD.

The text breaks it down into two distinct phases.

Phase one is the acute phase.

This is the disorganization phase.

It begins immediately after the assault.

The primary reactions are shock, numbness, and disbelief.

But what's tricky for the nurse assessing them is that the outward behavior can look like almost anything.

Right, the text contrasts what it calls the express style with the controlled style.

The express style is what we typically see in movies.

Crying, sobbing, hysteria, restlessness,

palpable anger.

It's very obvious outward distress.

But the controlled style, that's the real curve ball for a clinician.

The controlled style is dangerous if you don't recognize it.

The patient appears completely calm.

They are self -contained.

They might answer questions politely.

They might even smile.

And a lay person looks at that and thinks, oh, they're handling it really well.

Or worse, nothing bad must have actually happened.

Exactly.

But physiologically, that calm is a freeze response.

It is dissociation.

Inside their mind, they are in total chaos.

Physically, they might have generalized body pain difficulty breathing or severe nausea.

Emotionally, they are often dealing with crushing guilt and intense self -blame.

Then weeks later, we move into phase two, the long -term phase.

This is the reorganization phase.

It can last for months or even years.

This is where the classic PTSD symptoms really settle in.

Flashbacks, intrusive nightmares.

The text mentions new phobias developing during this time too.

Specific phobia is tied to the trauma.

If they were attacked indoors, they might fear being indoors.

If they were attacked outdoors, they might become agoraphobic.

They might just fear being alone anywhere.

And sexual dysfunction is very common.

A deep fear of intimacy.

And somatic symptoms.

That means physical symptoms stemming from an emotional cause, right?

Yes.

Gynecological symptoms are frequent.

Pelvic pain near regular periods.

It's basically the body keeping the score.

Right.

And psychic numbing.

They withdraw from their friends.

They stop doing things they used to love.

They just try to survive the day.

Other diagnoses, the text lists, include risk for self -destructive behavior, anxiety, and low self -esteem.

So we have the assessment.

We have the diagnosis.

Now comes the hard part.

Planning and implementation.

The actual treatment.

The text provides a case study of a patient named Margaret that really brings this to life.

I really love this case study because it shows the true art of nursing, not just the science.

It's a dialogue between a student nurse and Margaret, who's a 40 -year -old survivor.

Let's set the scene for you listening.

Margaret is 40.

She let a young man into her house to use the phone because he said he had car trouble.

He then assaulted her.

Now she's in the ED.

She's whispering.

She's trembling.

And we get to read the student nurse's internal monologue, which is so honest and important.

The student admits to struggling with counter -transference.

Let's pause on that specific word, counter -transference.

It's the nurse's unconscious emotional reaction to the patient.

The student looks at Margaret and thinks to herself, why did she let him in?

Who lets a stranger in nowadays?

That sounds a lot like victim blaming.

It is.

Yeah.

But as clinicians, we have to understand why the student is thinking it.

It is a psychological defense mechanism.

If the student can convince herself that Margaret made a mistake, then the student can tell herself, I wouldn't make that mistake.

Therefore, I am safe.

It's a way to mentally distance yourself from the horror of it all.

She failed, but I'm smart, so I'm safe.

Exactly.

It's self -protection.

But if the nurse acts on that thought, even subtly, she destroys the therapeutic relationship,

the student has to recognize that bias internally and shove it aside.

There's a moment in the dialogue where the student tries to comfort Margaret.

Margaret says, I feel so ashamed.

And the student responds, you have nothing to be ashamed of.

And Margaret immediately pulls away physically.

Why?

I mean, it sounds like a perfectly nice thing to say to someone.

It's what we call false reassurance in psychiatric nursing.

It sounds nice to the speaker, but to the listener, it feels like a total dismissal.

Margaret does feel shame.

That is her reality in that exact moment.

Telling her you have nothing to be ashamed of is essentially telling her your feelings are wrong.

It shuts her down.

So what should the nurse say instead?

Validate the feeling.

The student realizes her mistake and corrects course.

She says, I know I don't understand exactly how you feel, but I care about what happened to you.

That's honest.

It doesn't pretend to just fix it with a platitude.

Right.

It offers presence.

Then comes the truly pivotal moment in the case study.

Margaret calls herself a weak woman for not fighting back, for not stopping the monster.

This is where the nurse really earns her keep.

She has to reframe the narrative.

She doesn't argue about the fight or lack of a fight.

She focuses entirely on the result.

She says, you did what you had to do to survive.

Your instincts kept you alive.

You survived.

It shifts the entire identity from failed victim to successful survivor.

It validates that staying alive was the ultimate victory.

Margaret wasn't weak.

She was smart enough to survive a monster.

That cognitive reframing can literally be the difference between long -term recovery and lifelong shame.

Now, alongside the conversational therapy, there is the physical medicine.

We talked about the prophylaxis cocktail earlier.

It sounds like a simple drink, but it's a very heavy regimen.

It is a massive chemical load on the body.

Yeah.

Because we have to assume the attacker had everything.

So we give antibiotics right away for gonorrhea, chlamydia, and syphilis.

We give a tetanus shot if there were any cuts or scrapes.

We consider the hepatitis B vaccine.

And for pregnancy prevention.

Emergency contraception, usually pills like OVRL.

And the text makes a very specific ethical and medical point here that students really need to grasp.

This medication prevents pregnancy.

It does not induce an abortion.

Walk us through that distinction carefully.

Emergency contraception works by delaying ovulation or preventing fertilization from happening in the first place.

If the patient is already pregnant, say from a prior event, this pill will not harm the existing fetus.

It does not terminate an existing pregnancy.

It stops a new one from starting.

This is vital information to give patients who might have strong religious or personal objections to abortion.

And what about HIV prophylaxis?

That's evaluated on a case by case basis, depending on risk factors.

But it involves a heavy course of antiviral medications that could be notoriously hard on the body.

So think about this patient's experience.

She's traumatized.

She's had a four hour highly invasive physical exam.

She hasn't been allowed to shower.

And now we are handing her a fistful of pills that are going to make her nauseous, tired and physically weak.

It is a brutal grueling process.

That's exactly why the compassion piece, the communication we just talked about is so vital.

The medicine fixes the body, but the nurse has to hold the mind together.

We also mentioned psychopharmacology in the planning section, anxiety meds.

Yes, short term benzodiazepines like Xanax or Ativan might be prescribed just to help them sleep or to literally stop them from shaking in that acute phase.

But we use them cautiously.

Later on down the road, SSRIs or antidepressants are the gold standard for treating the long -term PTSD symptoms.

I wanna circle back to the date rape drugs.

The text has a whole section on prevention and education regarding these substances.

We need to understand what these drugs actually do to the brain.

The big three mentioned in the text are GHB, Rohypnol and Ketamine.

Let's start with GHB.

It's often called liquid ecstasy.

Don't let the street name fool you.

It is a severe central nervous system depressant.

It's often a clear liquid.

It can taste a little salty.

In very low doses, it creates a sense of euphoria, but the dose curve is incredibly steep, just a tiny bit more, and it causes unconsciousness, seizures, and even coma.

And Rohypnol, the classic roofie.

This is a benzodiazepine, but it is roughly 10 times stronger than Valium.

It causes what we call anterograde amnesia.

Which means what for the victim?

It means the tape recorder in your brain just stops recording.

You might be fully awake, walking around, even talking that you might be slurring, but you are not forming any new memories.

You wake up the next day with a terrifying black hole where the entire night should be.

And ketamine special K.

This is a dissociative anesthetic.

We actually use it in human and veterinary surgery.

Dissociative is the key word there.

Yes.

Think of your mind and body connected by a single cable.

Ketamine unplugs the cable.

Your eyes might be wide open.

You can hear what the attacker is saying to you, but you absolutely cannot move.

You cannot speak.

You become a prisoner in your own body.

It causes deep compliance, and again, severe amnesia.

That is quite literally the stuff of nightmares.

But the text makes sure to remind us what is the most common date rape drug of all.

Alcohol.

By a mile.

It significantly lowers inhibitions and impairs judgment, making all the other predatory scenarios so much easier for the perpetrator.

So what are the patient teaching points for safety strategies?

They are standard, but they bear repeating.

Never leave a drink unattended.

Don't accept open drinks from anyone.

And the buddy system.

If your friend has had two drinks but is acting like they've had 10, you get them out immediately.

Yeah.

That discrepancy, the intoxication level versus the actual consumption is the massive red flag that they've been dosed.

Finally, we reached the end of the nursing process.

Evaluation and outcomes.

How do you know if we've done a good job as nurses?

We look at short -term and long -term goals.

Short -term is immediate.

Does the patient have a concrete safety plan before they leave the emergency department?

Do they have a safe place to go?

Do they have the numbers for crisis hotlines?

Do they actually understand the medications they just took?

And the long -term goal.

The ultimate goal is a return to pre -crisis functioning.

We want them to fully process the event to move the memory from a present ongoing threat to a past finished event.

We want them to reclaim that title of survivor.

And eventually though, it may take years to regain the ability to have comfortable, trusting sexual relationships.

It's a really long road.

It is a marathon.

Recovery is not a straight upward line.

There will be serious setbacks.

But the text emphasizes over and over that with the right evidence -based care, especially that initial non -judgmental reception in the ED, true healing is possible.

We've covered an immense amount of ground today.

The history of the DOJ definition, the crucial forensic role of the Seneen nurse, the psychology of the perpetrator, the prophylaxis cocktail, and the immense power of our language.

It is a lot to absorb.

But if listeners take away just one single thing, I hope it's the power of that reframing technique.

Whether you are a psychiatric nurse, an ER tech, or just a friend.

When someone tells you they've been assaulted, your immediate reaction defines their next steps.

Believe them, validate them, remind them they survived.

I wanna leave you with a provocative thought.

Something that really stuck with me from the section on male victimization.

We talked about how male -on -male rape is so vastly under -reported because of the stigma wall.

It makes you wonder how much of our public perception of who is a victim is shaped entirely by our own gender bias.

If we don't socially see men as victims, we don't look for them.

We don't ask the right assessment questions.

And if we don't ask, they don't tell.

How many survivors out there are suffering in total silence simply because society hasn't created a safe space for them to speak?

That is the ultimate question for us to ponder.

Trauma absolutely does not discriminate by gender.

Our clinical compassion shouldn't either.

Thank you for joining us on this deep dive into chapter 22.

It was heavy, but it's completely necessary.

A warm thank you from the last minute lecture team.

We are signing off.