They didn’t ask for it

Sometimes, you just have to take a stand! Sometimes, enough is enough! How many times do we read about lawyers –or even judges- wondering about the effect of clothing on sexual assaults?

And it’s not just the criminal justice system that asks the question; I fear that it is a question that floats just beneath the surface of many a speculation –voiced or silently implied.

Blame seems to be a requisite component of justice however, and although it often is a focus for vengeance –sorry, punishment– it is always more satisfying if a reason for an action can be found. After all, an effect requires a cause, does it not? And post hoc, ergo propter hoc makes it even sound erudite. But, although it seems a logical outcome, it is a spider’s web that can be terribly difficult to disentangle unless we are motivated to take the counterintuitive step back from the seductive fallacy.

Admittedly, there are cultural differences that play a role in a society’s willingness to accept or at least tolerate excuses for behaviour, but in terms of the reasons for sexual assault, I would suggest that they are less cultural and more gendered. Excuses, not reasons. And, in these cases,  it is the action that must be examined, not the justification.

I found myself drawn to an article reporting on a woman in India who found an innovative way to draw attention to the issue: http://www.bbc.com/news/world-asia-india-42408844 ‘Indian artist-activist Jasmeen Patheja collects clothes donated by victims as testament to the fact they are not to blame […].’  Her project is called I Never Ask For It. And while the collection may seem a bit creepy, she maintains, ‘”It’s got nothing to do with what you’re wearing, there’s never any excuse for such violence and nobody ever asks for it. […] The project wants to contain and hold space for our collective stories of pain, and trauma.”’

It was a time when ‘[…] street harassment was being dismissed as just ‘eve-teasing’, something that boys do and girls must experience. It was being normalised. There was an environment of denial and silence around the issue, which made it okay to continue it. […] harassment in public places is all too common and almost every woman has experienced catcalls, lewd remarks, touching and groping. And anyone who questions it is told that the fault actually lies with them – she may have done something provocative, she may be wearing clothes that showed skin, she may have been out late at night, she may have been drinking, she may have been flirting: in short, she may have asked for it. “Girls are raised to be careful, we are raised in an environment of fear which is constantly telling us to be careful. We are told if you’ve experienced assault, then maybe you’re not being careful enough, that’s the underlying message we’re given.”

‘She set up the Blank Noise collective in 2003 to “confront” that fear. […]The first step to confronting any fear, Ms Patheja says, is to start a conversation around it and one of the things that Blank Noise does as part of the “I Never Ask For It” project is to gather testimonials from women. […] Almost all women chose to describe what they were wearing at the time of the assault and, Ms Patheja says, that’s what gave them the idea about the museum of garments.

“We found women often wondering about their garments. They’d say, “I was wearing that red skirt’, or ‘I was wearing that pair of jeans’, or ‘I was wearing that school uniform’. So it became a deliberate question at Blank Noise and we began asking, ‘so what were you wearing’? [..therefore..] we ask people to remember their garments, bring them in because they have memory, and in that memory it’s been a witness and it’s your voice.”’

I found that article very moving –especially that the clothes women had chosen to wear with pride at the time of the assaults had become forever tainted by the attacks –that those colours, fabrics, and even styles now made them feel sick. Guilty… Ashamed. They had expected admiration, approval, compliments, for how they dressed –or maybe hadn’t even thought much about their clothes beforehand. But, planned or not, a simple smile would have sufficed to indicate that they, too, could be beautiful. We all have a need for more than the mirror can say; most of us not only dress for ourselves, but in hopes our tastes will be vindicated. That we will be vindicated.

Yes, we often dress for effect, innocent or otherwise, and yet does the first chirp of the stirring robin cause the sun to rise? Are we looking at it the wrong way? Does attraction necessitate response? License behaviour? Does it even necessarily modify it? For some men, that is a vexing question, no doubt –and yet there it is. It has to be confronted. It is not enough for the man to say he was beguiled. That her clothes spoke for her –said what she chose not to say. That they told him all he needed to know… That they asked him and he merely accepted the invitation. Really?  He felt not only that entitled -that privileged- but also that omniscient? Stuff and nonsense!

Of course, how silly it all sounds divorced from the situation. After the fact. Even to other men, it would be difficult to argue his ability to know that he had been granted permission to violate someone else. To be assured that he could really see the world through his victim’s eyes…

As the Scottish poet, Robbie Burns put it: O wad some Power the giftie gie us to see oursels as ithers see us!

Because, no, they didn’t ask for it. And they certainly didn’t deserve it.

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The Tail and the Dog: Cause and Effect in Medicine

Does the tail ever wag the dog? Is an issue ever so compelling that cause and effect are reversed? Or at least suspended..? Sorry, I wonder about such things.

I remember reading a book many years ago by the British philospher A.J. Ayer called The Problem of Knowledge. In it he discusses a religious sect that believed its members were either born to go to heaven or born to go to hell. They spend their lives assuming and acting as if they were in the Heaven group, no doubt hoping to influence how they were born -the future influencing the past when you think about it. Effect influencing Cause. The very idea intrigued my teenage brain but I was unable to replicate the switch no matter how I tried. No matter the subterfuge, no matter the wording of the premise, I still ended up with a faulty syllogism.

But my misgivings have decreased in the intervening years and although I’ve never met a member of that sect, I believe I have encountered situations with eerie similarities. Disturbing parallels.

*

“I don’t think you’re really listening to me, doctor,” said the thin, immaculately coifed woman sitting across the desk from me. She’d been talking without interruption for five minutes or so. Sixty-five, and well into her menopause, she had short, greying hair, and a severe, noticeably-wrinkled face. She stared at me as if I had just insulted her and I could see her pale bony hands forming fists and silently massaging her lap as she spoke.

I’d just met her and was trying to understand why she’d been referred to me. “I’m sorry,” I said with a smile. “I was just trying to get a more complete history…”

“I’ve told you the relevent history doctor,” she interrupted impatiently. “You have to learn to listen!” I could tell she was deliberately italicizing words. The sigh that I tried to disguise did not go unnoticed, however, and her eyes sharpened like knife blades and attacked my face. “My doctor assured me you would listen to me.” She sounded almost petulant.

“Well perhaps I was too focussed on background details,” I said to mollify her, then sat back in my chair to indicate that I was, indeed, listening now.

“I have cancer, doctor. Nobody can find it, but I know its there as surely as I know this desk is hard.”

I kept my expression neutral and nodded for her to go on and explain things yet again.

“My sister died from squamous cancer of the cervix and my mother died of adenocarcinoma of the stomach,” she said, the terms obviously well-rehearsed. “And my uncle had some other kind of cancer that nobody could find until he died…”

That was certainly a lot of cancers I had to admit, but I couldn’t think of any obvious connecting factors. Stomach and skin derive from different tissues embryologically but the cervix cancer was almost certainly related to HPV –a sexually transmitted virus. And she didn’t know what type of cancer had killed her uncle.

Apparently satisfied that she had made her point, she straightened up in her chair and folded her arms tightly across her chest.

I nodded my head to encourage her to continue, but she merely slashed at me with her eyes, the skin of her face now tied so tightly I wondered if it would tear. I could see she was challenging me to contradict her. I managed a little smile but I didn’t really feel like it. “What makes you so certain you have cancer, Emily?” I thought maybe using her name might soften her face. “Is it the family history of so many cancers, or some symptoms you are experiencing?”

That seemed to catch her off guard and she unlocked her arms so her hands could wander back onto her lap. “It’s more of a feeling, doctor; it’s hard to explain.”

I sighed audibly and studied her face. It had gradually lost its anger and the skin seemed looser, older. She looked fragile now. Frightened. “Let me see what tests your doctor has done so far…”

“They’re all normal,” she said softly before I could even look at the referral letter. “I’ve been pestering my doctor for several years about my concern…” Emily looked almost embarrassed. “She did both abdominal and pelvic ultrasounds because I told her I was having pain. Then she did a whole bunch of blood tests to check my liver and kidney function but nothing showed up.” She stared at her hands for a moment. “I even convinced her to do a CAT scan of my head…” She looked up at me with a shy little smile hovering about her lips. “Headaches,” she said to ward off a question she could tell I was about to ask. And then she buried her eyes in her lap again. I could almost see her trying to think of something to convince me to keep searching.

“I’m tired all the time and I’ve been losing weight…” But even she didn’t seem convinced. Sad, burrowing eyes peeked out at me from behind deep ridges of skin that had come out of hiding as her anger dissolved. She chuckled half-heartedly. “I’m becoming so neurotic about this that sometimes I wonder if I’m creating a lot of these things out of whole cloth…” Her face brightened at the idiom.

Then she shook her head slowly. “You know, my cancer is almost like a religion: you have to take some of the tenets on faith alone. They don’t make sense, and you’d rather just ignore them, but something makes you go on. You still believe, because there’s something to it, something you suspect is true, even if you don’t understand why.”

I’d never thought of undiagnosed illness like that. I looked through the test results I’d been sent, but found nothing suspicious. No clues. Nothing that even suggested a direction for further investigations. Her pap smears were up to date and all normal; she’d  had a colonoscopy and had somehow convinced a gastroenterologist to investigate her stomach and esophagus. And a dermatologist had done some biopsies a couple of years ago because she had a few moles on her arms and legs. “Would you mind if I examined you?” I thought I’d better ask.

She shrugged and shifted in her chair. “You won’t find anything, but yes. You’re my last hope.”

Given the history, I have to say she had no more hope than I did of finding something. Anything. But I did a thorough examination –I took her blood pressure, I listened to her chest and checked her breasts for lumps. I palpated her abdomen for masses and pain. Lymph nodes filter out infections, but sometimes also tumor cells in the process of spreading, so I even felt for the lymph nodes in her groin to see if they were enlarged. People who run frequently have the occasional small lumps in their groins from incidental cuts on their toes, but she had some that were really quite large and painless, and on one side only.

Curious, I asked if she did a lot of running, or if she’d injured her foot or leg recently. She shook her head. “Do I look like a runner, doctor?” She had a point.

I was puzzled by the lumps, so I redoubled my search for an explanation. What had caused them? The only thing I could find, after doing the usual gynaecological examination, was a multicoloured, dark mole hidden in a labial fold near her vagina. It was on the same side as the lumps.

I finished my examination and asked her to come into the other room when she’d dressed.

“Did anybody mention they’d seen a mole near your vagina?” I asked, when she returned.

She shook her head. “I have moles everywhere,” she said, rolling a sleeve of her sweater past her elbow and showing me her arm. “I think everybody has been more focussed on my cervix because of my sister.” She couldn’t help smiling. “Even my GP just whips a speculum in whenever she’s in the area.”

“What about the dermatologist you saw?”

She chuckled. “He wouldn’t go anywhere near there.” Suddenly she stopped talking and looked at me. “Why? Is there a problem? The other moles were just benign nevi…” She had obviously been reading about her diagnoses.

“It’s an unusual place for a mole,” I said, somewhat hesitantly. “I think it should be removed.”

She studied me for a moment, nodded her head slowly, purposely, while the skin on her face tightened and then relaxed. Her eyes softened and she reached across the desk to grasp my hand.

“Thank you, doctor.”

I must have looked puzzled, because the smile on her face broadened in response.

“All these years…” she said, slowly, softly, and almost to herself. “I knew there was something; I just didn’t know where.”

“But…” I hadn’t even mentioned my concern about malignancy in the mole. If anything, I hoped I’d underplayed it so she wouldn’t panic.

She squeezed my hand. “I’d rather be on a path –any path- than wander around, lost.” She sat back in her chair, almost satisfied at the turn of events. “Our remedies oft in ourselves do lie, which we ascribe to Heaven.”

Wow: All’s Well That Ends Well. I wonder if she’d memorized that for just such an occasion. Perhaps she felt that discovery was tantamount to remedy for her… Vindication. Validation. I also wonder if Ayer would have understood.