At work yesterday, I was collaborating with our Mental Health Team Leader to develop a form to track the time our Centre invests in supporting the rapidly increasing number women in immediate crisis who walk through our door.
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To ensure that we are ever responsive to the needs of the women who seek us out, and to lobby harder for funding in critical areas, it's important for us to understand and capture the reasons that drive women at breaking point to us.
I started composing a list of what I thought were the primary reasons - escaping domestic and family violence, mental health crisis, homelessness, suicidality, addiction and several others - and in discussing these with my colleague, she said 'Really, Ali - the primary reason is always trauma. The other reasons are just the fall-out.' Being reminded of this in such simple terms rocked me to my core.
It was a sickening reminder at how shit we are as a society at not only failing to recognise and understand trauma, but instead heaping the blame on women's 'choices', 'emotions' and 'mental illness'.
The impact of trauma on women is all too frequently pathologised, meaning that we view it as a medical or psychological problem that we then make into an individual problem rather than a societal issue requiring broader societal solutions.
Victim blaming
It significantly impacts on how women are treated and supported, both by the healthcare system and by society.
Put simply - it's victim blaming, unfortunately another dimension of the overall toxic cultural dynamic.
Women are all too often blamed for their own experiences of violence or abuse, to be told that they were "asking for it" or that they" should have known better" than to put themselves in a risky situation.
This horrific victim-blaming mentality further isolates and disempowers women who are already struggling to cope with the effects of their trauma, and it makes it more difficult for them to seek help and support.
We pathologise women with trauma through often overzealous, gendered, and cavalier diagnoses and medicalisation of mental health issues.
Women who have experienced trauma, such as domestic and family violence or sexual assault, are often diagnosed with mental health disorders such as depression, anxiety, or PTSD in isolation without considering the root cause of these very natural responses, which demand at the very least a balance of holistic and therapeutic intervention.
Nowhere is classic pathologisation of trauma more evident than in the most ambiguous of mental health diagnoses - borderline personality disorder.
Women are significantly overrepresented in BPD diagnoses, with compelling evidence that those diagnosed with it overwhelmingly have trauma backgrounds.
While some diagnoses can be helpful in providing women with access to treatment and support, they can also serve to individualise and medicalise what are often systemic and societal problems.
Focusing on an individual woman's mental health, rather than on the root causes of her trauma, will often obscure the broader societal factors that contribute to trauma in women, such as gender inequality and violence against women.
We then label women with a diagnosis that will follow then around, and often used against them to deny housing, employment, health support, and vilify them in the criminal justice system.
Scrutiny and scepticism
Women who have experienced trauma, particularly sexual assault or domestic and family violence, are often subjected to intense scrutiny and scepticism when they engage with the criminal justice system.
Not always or only police - its often under examination by defence lawyers. They are often asked invasive questions about their sexual history and often their behaviour leading up to the incident, and their credibility may be called into question.
Not only does this have the significant risk of re-traumatising women who are already dealing with the aftermath of a horrific experience but can and does discourage other women from coming forward to report their own experiences of trauma.
In family court cases, workplace assault cases, general domestic and family violence cases - any mental illness diagnosis is eagerly seized upon by the opposing counsel and then weaponised against the woman in question, and if such a diagnosis doesn't exist, a mental health assessment will often be requested.
In a nation and region as diverse as Australia and the Illawarra, one of the most insidious aspects of the pathologisation of trauma in women is the way that it can intersect with other forms of oppression.
First Nations women, immigrants, women with a disability or LGBTQ+ women, will often face additional barriers to accessing support and may be at a higher risk of experiencing trauma.
These women are often discriminated against, marginalised or dismissed by the systems that are supposed to support them, compounding the effects of their trauma and making it even more difficult for them to heal and recover.
As we start to live longer as a society, we are seeing a frightening emergence and growing trend of elderly women in residential or home care environments experiencing sexual and physical assault - who due to their age and other factors like dementia, are dismissed with an airy 'she won't even remember it', or 'she must have imagined it'.
There are, however, positive signs of progress in Australia when it comes to recognising and addressing the pathologisation of trauma in women. There is a growing awareness of the need for trauma-informed care, which seeks to understand and address the impact of trauma on individuals in a way that is sensitive and supportive.
There are also increasing efforts to address the root causes of trauma in women through initiatives such as education programs, community outreach, and policy change.
The Illawarra is a leader in advocating for women who have experienced trauma and for driving cultural and systemic change to prevent it. And at the Illawarra Women' Health Centre we are proud to have played a significant role in this.
And as for our crisis form? We will keep doing what we are doing, tirelessly supporting and advocating for all girls and women suffering the fallout of trauma until the day comes when we no longer need to do so.
- Ali Anderson is General Manager, Illawarra Women's Health Centre