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Thursday Oct 19, 2017

Viral Response to #MeToo Shines Light on Need for Change

Amid the recent flood of stories about sexual harassment and assault, actress Alyssa Milano urged her 3.25 million Twitter followers to reply to her with "Me too" if they had ever experienced such violence. Milano told the Associated Press she hoped to show the magnitude "of just how many people have been affected."

Since Milano's original tweet on Oct. 15, there have been more than 1 million tweets with the #MeToo hashtag. We asked some of our new physician bloggers to share their thoughts on the issue. Here are their responses:

[Alyssa Milano's original

Knowing How They Feel

I was 17. Most people would say I was lucky because I wasn't raped, but that was only because I was stronger and faster than him. I was able to fight my way free by some adrenaline-charged miracle, and then I was able to outrun him. That terrifying night changed my life and gave me the never-ending gift of posttraumatic stress disorder. I didn't formally report the assault because I never wanted to see him again, not even in court.

Unfortunately, I have seen him again because society doubts women and downplays our trauma. He has a seat at Thanksgiving dinner and exchanges gifts with my family on Christmas Eve, while I stay home because I don't feel safe around him.

When #MeToo started trending on social media, I proceeded to have the typical nightmares, flashbacks and insomnia that I get every time sexual violence information crosses my path. I read IMDb (Internet Movie Database) parents' guides before I watch TV shows and movies to help protect myself. I can't walk to my car, go on a run, use a public restroom or, honestly, do anything without envisioning someone attacking me.

As a family physician, I can't avoid seeing patients who have been sexually assaulted, but I can admit it is the hardest encounter for me to have. I tell patients who have been assaulted that I, unfortunately, have been in their shoes, that I know how they feel and how they are going to feel, forever.

Kimberly Becher, M.D., Clay County, W.Va.

Never Too Young

I saw the #MeToo hashtag on a friend's Facebook post. I wasn't familiar with it and had to look it up to see what it meant. After I read about it, my initial instinct was to go to my Facebook account and post it, as well. I clicked on my page and began to type but stopped. I remembered multiple episodes of sexual harassment, going back to one teacher who harassed me throughout an entire semester during my freshman year of high school.

But I stopped short of posting because I wondered whether what I had endured was "bad enough." Is what I experienced "enough" to be considered gender-based violence or harassment? I pondered this throughout the day and, in fact, did not post until 11 p.m. that night when I realized that what happens to everyone is important. For every one of us who has talked about our experiences, there are at least as many who haven't.

I have two daughters, and I want them to grow up in a world where people speak up and speak out on issues such as this. I had the first conversation with my oldest daughter about misogyny and gender bias when Donald Trump was running for president, and she was only 4 years old. I was reminded during those conversations that some men in positions of power (like my former teacher) will continue to normalize sexist behavior as "locker-room talk" for as long as we let them, and it's never too young to learn that behavior like that is unacceptable.

Beth Oller, M.D., Stockton, Kan.

All Voices Needed

Unfortunately, I also posted #MeToo on social media because of my own experiences as a woman in this world. Even as a female physician -- in my white coat, in my office -- I have been placed in uncomfortable positions. For example, I was once unexpectedly kissed by a patient behind a closed door, which quickly changed the power dynamics in the room. It's interesting that even in a space where a white coat has traditionally indicated authority, a violation based on gender can void that power.

I appreciate that the #MeToo campaign provides a forum for an overwhelming number of women to identify themselves as victims of sexual harassment and sexual abuse. I notice, however, that there are some important voices missing -- largely those of men. Although the statistics show the percentage of men who have experienced sexual violence(www.rainn.org) is small in comparison to women, I have had several male patients come to me as their physician and reveal their painful truth of being sexually abused. Additionally, I have had male patients reveal their truth as an abuser.

If we really want to solve the problem, don't we need all voices present, including the abusers acknowledging their role? I know it is uncomfortable, but honesty often is.

Venis Wilder, M.D., New York

Calling on All Men

Of course, #MeToo.

When my newsfeed filled with the voices of the women's health community, I learned two critical things. First, although actress Alyssa Milano may have given the #MeToo hashtag a national spotlight, it actually was started more than 10 years ago(www.washingtonpost.com) by black activist Tarana Burke. The message has been ignored too long.

Second, although #MeToo is a powerful visual message and a source of solidarity among women, it is problematic in that it asks only victims -- not perpetrators -- to take action. The burden too frequently falls on victims, most commonly women. Ending the pervasive sexual harassment and assault that creates rape culture requires men to also raise their voices and take action. Instead of solely focusing on how many women are victims of sexual harassment and assault, we should also be talking about the risk of men committing these acts and the reality that many already have. We need conversations about rape culture, and men should recognize their responsibility in changing it. Men need to challenge rape jokes, refute degrading comments, break down gender stereotypes and model for one another a progressive masculinity that does not include exerting power over women or degrading them.

In response to #MeToo, I have seen men say that they are sorry, while others have excused themselves from guilt by explaining they never harassed or assaulted a woman. This is not helpful. What is going to change our culture is acceptance of responsibility and efforts to challenge sexual harassment and assault by the most common perpetrators: men.

Natalie Hinchcliffe, D.O., Cleveland

Validating Experiences of Others

My Facebook feed is littered with #MeToo and stories of sexual harassment and assault. In response, I've heard well-meaning, but disconnected, words of support from friends who can't fathom a reality where these episodes occur. Words like, "You are so strong to live that," or "I could never handle that," dismiss the very real experience of harassment or abuse as unrelatable.

I get it. There's a desire to participate in the dialogue. But when we're outsiders, we can push against others' experiences with pity or incredulousness. Many times, I've reacted to stories of harassment or abuse with a personal opinion or visceral response. In doing so, I've diminished the weight of someone's reality.

In the patient room, however, my behavior is different. I've trained to listen deeply to patients. I try to acknowledge their truth without inserting my opinion about their actions or my feelings about their situation.

In family medicine, there is a push to understand our patients' backstory -- their social determinants of health -- and meet them where they are. When we do this, we stop telling patients who feel unsafe in their neighborhood to take a daily walk outside. We don't breeze by the question, "Do you feel safe at home?" when talking to a woman with an undesired pregnancy. We ask patients who laugh nervously about their last sexual encounter whether it was consensual. When we become aware of the realities of others, our perspective changes, as does the quality of care we provide.

We can use this training outside of our medical practice, as well. By listening with awareness to women -- or to any group with experiences different from our own -- we can validate their reality by fathoming it as relatable. When we do that, we humanize what we did not understand before and maybe understand each other just a little bit better.

Lalita Abhyankar, M.D., M.H.S., New York


#MeToo is a powerful tool in combatting the normalization of sexual assault and harassment. Learning of the battles that family, friends, colleagues and strangers have faced brings to light a network of support essential for this movement. But running a family medicine practice for people who have experienced sexual violence has also taught me that the decision to disclose is deeply complex.

As a physician, #MeToo includes #ThemToo.

Women who have nightmares about when they were sexually assaulted in jail, prison and immigration detention centers; I've been the family doctor for #ThemToo.

Women with substance use addictions who have been told it's their fault for being raped; I've been the family doctor for #ThemToo.

Women who were drinking alcohol at the time of an assault and want to just "get checked and move on with life" because they don't think anyone would believe that they said no; I've been the family doctor for #ThemToo.

Women seeking asylum in the United States after experiencing sexual assault as a tool of war in their home country, and who feel guilty for bringing shame to their families; I've been the family doctor for #ThemToo.

Women who come in for treatment for injuries after sexual assault but do not tell police for fear of deportation; I've been the family doctor for #EllosTambien.

Children who are not old enough to post on social media but have already experienced being swabbed for sexually transmitted infections after sexual assaults; I've been the family doctor for #ThemToo.

Survivors who are transgender and survivors who are men; I've been the family doctor for #ThemToo.

The absence of #MeToo on a tweet or post does not equate to the absence of experiencing sexual violence. As physicians, we see #ThemToo.

Anita Ravi, M.D., M.P.H., M.S.H.P., New York City

Posted at 04:30PM Oct 19, 2017 by Kimberly Becher, M.D.

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