FAQ: Chronic vs Acute Abuse

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Today’s post is a biggy. Not that there is ever anything small about abuse of any kind, but another blogger asked me a question the other day about the word Chronic and what it is. This is SUCH an important question, and the answer even more so.

All around us these days we see stories of the most traumatic and unbelievable abuse, from fathers and strangers stealing and hiding young girls in their basements for years on end, to brutal attacks and rapes. Like it or not, because it is everywhere on the news, in movies, and on the small screen, we are becoming somewhat desensitised to them. We are still horrified and we are still shocked, but the line has become blurry between what is real and what isn’t, but worse than that, is that our measure of what we think abuse is, is so extreme that we miss a different more subtle kind of abuse that is often right under our noses.

Domestic Abuse is also very much in the spotlight right now (and rightly so) and on those screens we see women with black eyes and swollen lips, purple and blue bruises and frazzled hair. The look in their eyes often speak even more deeply of the tragedy and the violence, as well as the deep emotional pain that they are in. We are shocked and horrified and look around us but don’t see anyone in our neighbourhood looking like that and so we assume that we don’t know anyone who is, or ever has been abused.

Sexual abuse is another deeply traumatic and violent act that we see on the big screen. This one in theory we know happens all around us, but we don’t like to pry or ask. 1 in 4 girls, and 1 in 6 boys have been sexually abused in one way or another, and we assume that for all of them, they are people we don’t know, and that they were physically raped.

Abuse can be at the hands of loved ones or strangers and it can take many forms. Physical and sexual abuse are the obvious, but we do hear from time to time about emotional abuse. I don’t want to take anything from these deeply tragic and abusive physical situations, but my concern in this article is for both women and men and a different kind of abuse. One that goes “unnoticed” and “non validated” sometimes even by the victim. Emotional abuse is much harder to define and capture, and because it goes hand in hand with squashing the voice of the victim, it is very hard to see or even measure the impact. For these as well as those who are more “subtly” sexually abused, there are no dark basements, no physical bumps or bruises, but the damage can, and often is, just as bad.

Let me go back a step and explain a very important concept, the difference between Chronic and Acute. We often hear these two words associated with medical things and the easiest way to explain it is to use a cough as an example. Someone with an acute cough would have a really really bad one. It may even be Pneumonia. It requires hospitalisation to treat the cough and maybe even save the patient’s life. We all get a huge fright especially the patient who is suffering tremendously.

A chronic cough on the other hand doesn’t look so bad, but it goes on and on and on. A normal cough virus (or bacteria) should last no longer than 10 days, and then if all goes well it goes away. But a cough that lingers for weeks or months or a cough that is not so bad and heals, but keeps coming back over and over again can be a sign of something  else far worse going on.

Take a different example. Say someone hit you over the head with a hammer. Hard enough to knock you out and leave you in hospital with a major head injury. That is called a brain trauma and it is a massive assault. It is called an acute trauma.

But what if someone only hit you with a rubber mallet? Not hard enough to knock you out or cause any “damage”, but they did it over and over and over again. What if every time you woke up someone hit you once on the head with this soft rubber mallet. Over time, it would still be a trauma, but a different kind of trauma, a chronic trauma. The mild bruising that occurred would never get the chance to heal, and the same spot would become tender and damaged in a different way. The bruising and healing would become stagnant and the body would not get a chance to take the damaged cells away. A blood clot could form and the person could eventually have a stoke and land up in hospital in just as bad shape as the person who was hit hard with a metal hammer that broke through their skull. This is called chronic trauma.

Much of this may seem obvious to a lot of people when looking at the outside world or the theory of abuse, but I have a huge heart for men and women who live in all kinds of chronic abuse. Bullying is a perfect example of constantly and consistently being emotionally (or even physically) hit over the head with a soft rubber mallet.

Physically it can mean a parent, sibling or school mate who constantly and regularly smacks you on the back of the head “in jest” each time you walk in the door. One whack can be funny, or simply “not nice”, but when you can’t ever get them to stop, it is abusive. More than that, it may look physical but it is actually emotional. For the bully it is a mild yet chronic way to remind someone who has the upper hand, over and over and over again. To constantly and consistently knock a person down a peg. It may not be about squashing them under foot, but it is a way of never allowing that person freedom to grow or branch out. It is about keeping that person trapped by fear and insecurity.

If someone who is hit over the head like that every single day complains, we tend as a society to measure that against the stories on the TV. We assure them that what they are suffering is nothing compared to “real” abuse and tell them that they should be thankful that it isn’t worse. We tend to judge their experience and diminish it, and we don’t help them to rise above it and to stand up to the “bully”. But no one likes to stand up to bullies right? …and anyway, these kinds of bullies are so subtle and because as they whack us they laugh and tell us that they love us, or scruff our hair …. No one else notices the victim’s hurt, and we all think that the bully is wonderful for saying that they love them. The victim then often feels bad, as though being hurt (emotionally or physically) is their own fault, and that they should the bully like everyone else does. And so way too often these kinds of experiences are never validated or recognised.

This chronic abuse can be emotional or it can be sexual as well. We constantly hear of rapes, multiple rapes, and the massive, life destroying impact on the victim by these massive, acute, sexual, emotional and physical traumas, and my heart absolutely breaks for the victims both at the time and forever onwards. But what if a young boy or girl was being chronically abused? What if a family member kept trying to look at and laugh at her budding breasts? What if she was mocked for not growing them fast enough or big enough for someone’s liking? What if a mother kept “accidentally” leaving the buttons of her shirt undone and wore no bra when her young son is the only one home and tries to get him to have an eye full, …then mocks him when he tries to look away? What if there is no sexual touch as such, but while watching TV many evenings a mother sits way too close to her hormonal teenage son, becomes sexually aroused and makes comments and gestures that leave him feeling ill and confused, or a father who does the same to a daughter and his breathing becomes heavy and hot on her neck? What if all these children have no words to explain their experiences and one to tell anyway? What if they are confused and degraded confused about what they are feeling anyway? What if when they try to verbalise it even to themselves they sound like they are making mountains out of molehills and so they silence themselves in fear of sounding stupid or being told that it is their fault?

In a completely different way, what of the child who is constantly mocked by her parents for the colour of her hair or the freckles on her face? What if she is mocked and blamed for being a girl instead of a boy? What if the focus was too much on the negative and not enough on the positive and that she was never equipped for the world out there? What if she is never taught skills to use her voice, to stand up for herself, to ask healthy questions, or to find her own skills and passions, … what if she doesn’t know how to healthily say no? What if her parents kept her isolated from family and friends so that there were no other influences on her life to fill in the gaps that she so desperately needed? What if she was never cared for medically and always told that she was making it up, …so no one even looked to see what was going on under the surface?

Silence and secrets, unspoken pain and confusion, youth and innocence … all these things conspire against anyone who grows up in or lives with chronic abuse; the constant hits on the head by a rubber mallet, which dull our senses and keep us in fear. For every battered face there are a dozen battered hearts and broken souls. For every rape there is a handful of sexually broken men and women who don’t understand what is going on other than that somehow it hurts like hell.

Much of that emotional abuse is mild, but psychologically a good chunk of it is actually not as subtle as it appears. But even if it is all mild, the constant whacking over the head with the emotional hammer, all through a child’s growing years, does not equip him or her for adult life. It sets paths for their future which were no where near to the God-given potential that they was born with. Patterns were set for choosing partners, building relationships, and the bruised and battered effects of abuse continue into adult life….

Unless … what if they are brave enough, and strong enough and manage to break free… to start on a decades long lonely, exhausting journey to achieve what is supposed to be the impossible, …and what if they are prepared to lose everything to get there?

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