SELF- ESTEEM OF RAPED W OMEN
Lucila Am ar al Car neir o Vianna1 Gr aziela Fer n an da Teodor o Bom fim2 Gisele Ch icon e3
Vianna LAC, Bom fim GFT, Chicone G. Self- esteem of raped wom en. Rev Latino-am Enferm agem 2006 setem bro-out ubro; 14( 5) : 695- 701.
This qualit at ive st udy shows t he result s of workshops held wit h healt h workers and public healt h users ( r aped w om en) , aim ed at r aising t hese w om en’s self- est eem and cr eat ing aw ar eness am ong healt h w or k er s w ho at t end t hem . Neur o- Linguist ic Pr ogr am m ing t echniques w er e used t o br ing back life ex per iences, w hich cont r ibut ed t o a r e- r eading and t o m inim ize causal fact or s of low self- est eem . Them es lik e r epugnance, fear and t he fruit of rape; im age and place; deat h; revenge; support and solidarit y; dom est ic violence and bad care delivery t o vict im s were addressed during t he m eet ings. The st ories were t ranscribed and analyzed, preserving cont ent fidelit y. Experiences lived at hom e and wit h loved and adm ired people, and m ainly experiences result ing from t he rape were responsible for t he low self- est eem . The evaluat ions indicat ed t he workshops as an opport unit y t o r eflect , t o r et ur n t o nor m al life and t o r econst r uct self- est eem , for t he r aped w om en as w ell for t he healt h w or k er s w ho deliv er car e t o t hem .
DESCRI PTORS: self concept ; w om en; v iolence; r ape
AUTOESTI MA DE LAS MUJERES QUE SUFRI ERON VI OLENCI AS
Est e est udio cualit at ivo m uest ra result ados de oficinas de aut oest im a realizadas con usuarias ( m uj eres que sufrieron violencia sexual) y profesionales de inst it uciones de salud, con obj et o de elevar la aut oest im a de esas m uj eres y sensibilizar los profesionales que las asist en. Con las t écnicas de la Program ación Neurolinguíst ica, sur gier on ex per iencias v iv idas, fav or eciendo nuev a lect ur a y m inim ización de los fact or es causales de la baj a aut oest im a. En los encuent r os, fuer on t r at ados t em as com o: asco, m iedo y el fr ut o de la v iolación; im agen y local; m u er t e; v en gan za; apoy o y solidar iedad; v iolación dom est ica y la m ala at en ción a las v ict im as. Las h ist or ias f u er on copiadas y an alizadas, m an t en ien do la f idelidad del con t en ido. La r espon sabilidad por est e pr oblem a de baj a aut oest im a v ino de ex per iencias negat iv as v iv idas en el hogar y con per sonas de nuest r o cir culo de afect o e adm ir ación, pr incipalm ent e las que sur gier on con la v iolación. Las ev aluaciones m ost r ar on que las oficinas const it uyen un m edio de reflexión, ret orno de la vida norm al y reconst rucción de la aut oest im a, t ant o par a las v ict im as de v iolencia sex ual com o par a los pr ofesionales que las asist en.
DESCRI PTORES: au t oim agen ; m u j er es; v iolen cia; v iolación
AUTO-ESTI MA DE MULHERES QUE SOFRERAM VI OLÊNCI A
Est udo qualit at ivo que m ost ra result ados de oficinas de aut o- est im a realizadas com usuárias ( m ulheres que foram violent adas sexualm ent e) e profissionais da área da saúde, com o obj et ivo de elevar a aut o- est im a d essas m u l h er es e sen si b i l i zar o s p r o f i ssi o n ai s q u e as at en d em . Fo r am u t i l i zad as t écn i cas d a PNL, q u e possibilit ar am t r azer à t ona ex per iências v iv idas, cont r ibuindo par a um a r eleit ur a e m inim ização dos fat or es causais da baix a aut o- est im a. Nas oficinas for am abor dados t em as com o: o noj o, m edo e fr ut o do est upr o; im agem e local; m ort e; vingança; apoio e solidariedade; violência dom ést ica e o m au at endim ent o às vít im as. As h ist ór ias f or am t r an scr it as e an alisadas, m an t en do a f idelidade dos con t eú dos. Respon der am pela baix a aut o- est im a ex per iências v iv enciadas no lar e j unt o a pessoas pelas quais se nut r ia afeição e adm ir ação, e aquelas adv indas pr incipalm ent e da v iolência sofr ida. As av aliações apont ar am as oficinas com o opor t unidade de reflexão, ret om ada da vida norm al e reconst rução da aut o- est im a, t ant o para as vít im as da violência com o par a os pr ofissionais da saúde que as at endem .
DESCRI TORES: au t o- im agem ; m u lh er es; v iolên cia; est upr o
1 Full Professor at the Paulista Medical School, e-m ail: [email protected] .br; 2 RN, Hospital São Paulo. São Paulo Federal University; 3 RN, Hospital São Luiz
I NTRODUCTI ON
T
his proj ect grew out of the researcher’s and her r esear ch gr oup’s per cept ion and ex per ience in care delivery t o wom en at basic healt h unit s and in t h e o r g a n i za t i o n o f sel f - est eem w o r k sh o p s t h a t in v olv ed st u d en t s, em p loy ees an d clien t s. Th ese research results allow us to affirm the close connection bet ween t he im pact of social condit ions on wom en’s h ealt h an d discr im in at ion or social r epr ession an d sexual violence; t hese st udies also indicat e low self-est eem as a param ount fact or caused by sit uat ions o f e x cl u si o n , a b a n d o n m e n t , n e e d a n d t h r e a t e x p e r i e n ce d i n r e l a t i o n s, e n t a i l i n g n e g a t i v e consequences for qualit y of life( 1- 2).Acco r d i n g t o Ma sl o w ’s h i e r a r ch y, a f t e r sat isfying our physiological needs, we hum an beings feel safety needs, related to shelter and protection of our physique, fam ily, hom e and com m unity; next, we feel needs for est eem relat ed t o t he ego - self- love, sel f - est eem , sel f - r esp ect , co n f i d en ce - n eed f o r r eco g n i t i o n , a p p r eci a t i o n a n d a d m i r a t i o n( 3 ). Th e
sat isfact ion of self- est eem needs m ak es indiv iduals feel confident ( about t heir value, st rengt h, capacit y and adequacy) , m ore useful and needed in the world. Non- satisfaction, on the other hand, produces feelings of inferiorit y, weakness and im pot ence in individuals. The persist ence of t hese feelings will lead t o failures i n t h e i r t r a j e ct o r y o r d i f f e r e n t p a t h o l o g i ca l pr ocesses( 4). Basic needs ar e int er link ed and w
ell-being depends on safet y : t he safer w e feel in t he environm ent we are part of, the m ore our self- esteem w i l l b e r a i se d b y co n f i d e n ce a n d r e sp e ct a n d , consequent ly, cont inue high.
Accident s and v iolence der iv e fr om hum an action or om ission, linked up with certain conditioning fact or s, such as social aspect s, w hich cause healt h dam age and ar e included in t he gr oup of “ Ext er nal Causes”, which cover t he following accident causes: traffic, work, falls, poisoning, drowning, am ong others; and int ent ional causes: aggr essions and self- har m . I f, on t he one hand, t he accident cur v e is dir ect ly p r o p o r t i o n a l w i t h t e ch n o l o g i ca l a n d u r b a n d ev elop m en t , on t h e ot h er, v iolen ce in cr eases in h u m a n h i st o r y a n d i s d i r e ct l y co n n e ct e d w i t h individuals’ behavioral and sit uat ional m at t ers( 5).
I t is fundam ent al t o clearly underst and t hat t h e d if f er en ce b et w een g en d er s is t h e or g an izin g elem ent of all inequalit ies bet ween m en and wom en in t he public and privat e spheres, breaking wit h t he
t radit ional argum ent t hat t ries t o explain t he m ale-f e m a l e d i ale-f ale-f e r e n ce b y m o t h e r h o o d a n d r e st s o n dom estic values for wom en. However, insisting on this d i f f er en ce as t h e essen ce of w om an h ood m ean s m ain t ain in g t h e p ow er r elat ion b et w een g en d er s. Wom en hav e incr easingly conquer ed t heir r ight s in recent decades, alt hough unequal relat ions bet ween t he sexes st ill cont inue, leading t o serious problem s, the worst of which are assassinations, often resulting from sexual violence against wom en( 1).
On e o f t h e m o st d e b a t e d i ssu e d b y t h e fem inist m ovem ent is the acquisition process of fem ale identity, which psychology has identified as the enigm a of wom anhood and, in this context, dependence. This has been pointed out as one of the m ain obstacles to t h e adv an cem en t of w om en . Th in gs seem clear er w hen w e r efer t o econom ic dependency, or t o t he liv in g con dit ion s n eeded t o ex per ien ce au t on om y. However, t his ground becom es m uch less solid when t he realit y of affect ive dependence appears( 6).
The aut hors ask t he follow ing quest ions: is wom en’s self- est eem relat ed t o t heir financial and/ or affect iv e depen den ce/ in depen den ce? I s it possible t h at m en con sid er t h em selv es t h at su p er ior an d , t herefore, sexually violat e w om en?
Th e d ep en d en ce co n cep t t en d s t o co v er different t ypes of phenom ena, including t he one t hat m e a n s su b m i ssi o n , i . e . w o m a n ’ s i n ca p a ci t y t o m aint ain herself, condit ioning her in funct ion of t he ot h er ; an d depen den ce t h at m ak es w om an adapt h e r se l f t o t h e o t h e r p e r so n o u t o f f e a r o f abandonm ent . On t he ot her hand, dependence can derive from t he need for t he ot her person t o fill in affect ive lacks. While dependence is a bot t leneck for wom en’s liberation, lacks are inherent to the condition of social being. I n other words, affective needs cannot be m ixed up wit h t he absence of aut onom y t hat has placed wom en in a subm issive relat ion in t he public and privat e spheres( 1).
Violence against wom en is considered t o be any inj ury caused by m en, which results or can result i n p h y si ca l , se x u a l o r p sy ch o l o g i ca l d a m a g e o r suffer ing, including t hr eat s of t hese act ions, or t he ar bit r ar y w it hdr aw al of fr eedom , w het her pr oduced in public or in private life( 1).
I ncidence lev els of sex ual v iolence, i. e. of r ap e* ag ai n st w o m en h av e b een r i si n g , cau si n g p h y sical an d p sy ch olog ical seq u elae an d m ak in g vict im s m or e vulner able t o ot her t ypes of violence, p r o st i t u t i o n , d r u g s u se , se x u a l l y t r a n sm i ssi b l e diseases, gy necological diseases, sex ual disor der s, depression and suicide.
Sex u al abu se is st ill con n ect ed w it h ot h er behav ior al pr oblem s, such as t he abuse of alcohol a n d o t h e r d r u g s a n d u n sa f e se x w i t h m u l t i p l e par t n er s( 7 - 8 ). Th is m ak es ar t icu lat ion bet w een t h e
h ealt h , ed u cat ion an d saf et y ar eas f u n d am en t al, suggesting j oint actions between the three institutional spheres. Moreover, organized groups are needed, with wom en working against violence, i.e. the im plantation of program s t o m ake professionals from t hese areas aware of t he issue.
I n Br azil, t h e r ep or t in g of sex u al cr im es rem ains low and t he act ual num ber of cases great ly exceeds police and j udicial st at ist ics. The Minist ry of Healt h ack now ledges t hat less t han 10% of sex ual violence cases are not ified t o t he police st at ion. The sex u al v iolen ce scen ar io in t h is cou n t r y pr odu ces se r i o u s r e p e r cu ssi o n s f o r p u b l i c h e a l t h a n d f o r w om en’s and adolescent s’ hum an r ight s, indicat ing the need to reduce existing adm inistrative and cultural barriers wit h a view t o full healt h service access( 9).
Mo st h e a l t h se r v i ce s l a ck t r a i n e d p r of ession als t o r ecog n ize sig n s of v iolen ce. Th is diagnosis requires a support group t hat goes beyond the health services, with a view to the solution of the id en t if ied p r ob lem s an d t h e easier su r p assin g of t raum a resulting from this type of violence. Moreover, the health sectors should receive the victim s, seeking to m inim ize pain and avoid other inj uries. This j ustifies t h e r eal i zat i o n o f sel f - est eem w o r k sh o p s, w h i ch strengthens these wom en and helps them to dissociate t h em sel v es f r om t h e t r au m a t h ey su f f er ed . On e ex am ple of t h e j oin t w or k dev eloped by dif f er en t healt h pr ofessionals is t he Wom en’s Suppor t House Professor Dom ingos Deláscio, since 1999.
This r esear ch look s at t he im pr ov em ent of w o m e n ’ s se l f - e st e e m t h r o u g h w o r k sh o p s t h a t com plem en t t h e car e t h ey r eceiv ed at t h e Hou se, besides focusing on som e int er connect ed pr em ises, i. e. subm ission, dom est ic v iolence and par t icular ly se x u a l v i o l e n ce , w h i ch h a s co n t r i b u t e d t o t h e det er ior at ion of m any Br azilian w om en’s qualit y of life and healt h. Thus, t his st udy aim s t o present t he workshop as a t ool t o help wom en reconst ruct t heir self - est eem an d cr eat e aw ar en ess am on g h ealt h pr ofessionals.
METHODOLOGY
Th e r e se a r ch p r o j e ct w a s a sse sse d a n d approved by t he Research Et hics Com m it t ee at São Paulo Federal Universit y. The regist ered part icipant s were inform ed about it s goal and t heir part icipat ion on a volunt ary basis.
This is a qualitative study, because it intends t o w or k w it h people, w it h r elat ed social act or s and wit h specific groups ( healt h service users and healt h p r o f essi o n al s) , an d “ . . . i n t h e f i r st p l ace, t h ese r esear ch su bj ect s ar e t h eor et ically con st r u ct ed as co m p o n e n t s o f t h e o b j e ct o f st u d y ”( 1 0 ). He n ce ,
q u alit at iv e in st r u m en t s w er e u sed t o ach iev e t h e p r o p o se d o b j e ct i v e , t o a n a l y ze t h e se l f - e st e e m p r ocess, u sin g in t er d iscip lin ar it y am on g d if f er en t k n ow led g e ar eas ( cr ossed w it h g en d er r elat ion s) t hr ough life st or ies. This m odalit y, w hich basically r e su l t s f r o m t h e co n t r i b u t i o n s o f An t h r o p o l o g y, Sociology and Com m unication, allows us to study the phenom enon m ore profoundly and t o underst and t he com plex it y of fact or s int er v ening in t he “ cult ur e of low self- est eem ”, m ainly am ong w om en v ict im s of violence; const ruct ing a relat ionship of t rust bet ween t h ese w om en an d t h e r esear ch er s, in w h ich t h ey expose their situation and their life experiences, thus perm it t ing a reflect ion and expect at ion of behavioral change in relation to their own self- esteem . Moreover, t he t heor et ical- m et hodological r efer ence fr am ew or k of int ersubj ect ive relat ions perm eat es all part icipant so ci al su b j ect s, as w el l as t h e r el at i o n b et w een r esear cher s and subj ect s.
Hence, w e believ e t hat t he v alidit y of t his st udy rest s in it s capacit y t o concret ize t he abst ract obj ect in all of its dim ensions, in this case through the
different workshops, focus groups and t he qualit at ive assessm ent pr ocess.
We report the results of five wom en’s groups ( w o r k sh o p s) , each o f w h i ch i n cl u d ed f i v e o r si x m eetings, started with wom en victim s of violence who looked for help at t he Wom en’s Support House Prof. Dr. Dom ingos Deláscio of São Paulo Federal University. Pa r t i ci p a n t s i n e a ch g r o u p a l so i n cl u d e d f i v e em ployees who norm ally receive and deliver care t o t hese wom en, leading t o professional awareness.
St art ing from t he prem ise t hat , t radit ionally, in ou r cu lt u r e, y ou n g b oy s alr ead y r eceiv e m or e posit iv e st im uli t han gir ls, w hich w ill r eflect in t he form at ion of t heir personalit y and t he const ruct ion of their self-esteem , we used Soeiro, who states that “ if we continue without positive stim uli from our audiences for a long tim e, if we do not hear the sound of applauses during a considerable period, we will definitely feel bad. We tend to get depressed and feel insecure about our ca p a ci t y. Ho st i l e o r i n d i f f er en t a u d i en ces ca u se subst ant ial dam age t o our self- est eem ”( 11).
The sam e aut hor’s st udies gave rise t o t he use of dram a techniques, based on Psychodram a, for t he w or k shops, for par t icipant s t o under st and t heir own realit y wit h a view t o finding bet t er answers t o t he new sit uat ions( 11). Moreover, t he workshops were
b a se d o n t h e p r i n ci p l e s o f Ne u r o - Li n g u i st i c Program m ing ( NLP)( 12- 13), which includes t hree ideas:
- 1st “ Neuro”, acknowledges all behaviors on the basis
of the neurological processes of sight, hearing, sm ell, t ast e, t ouch and feeling, as t he w or ld is per ceiv ed through the five senses, “ understanding of inform ation befor e act ion”.
- 2nd “ Linguist ic”, i. e. language t o or der t hought s,
behaviors and com m unicat ion am ong individuals. - 3rd “ Program m ing”, refers to the organization of ideas
and act ions t o produce result s.
Finally, NLP adopts an attitude of curiosity and fascination instead of starting from prem ises, bringing back t he subj ect iv e ex per ience and ex pr essing t he nat ure of t he int ernal experience( 12).
Dram a and life line st rat egies were used t o allow t h e w om en t o br in g t h eir ex per ien ces sin ce childhood and reflect about t hem . This perm it s a re-reading in order to elaborate new concepts about their condit ion of being a wom an.
Thus, we developed t he following m odules: - Self- help for t he wom en t o survey t heir problem s, which did not need t o be connect ed t o t he violence t hey suffer ed;
- em er g en ce o f h i g h sel f - est eem a s o n e o f t h e elem ent s needed t o exercise cit izenship;
- assessm ent t hrough t he part icipant s‘ experiences, t old during t he workshops.
I n each group, gam es were used to approach t h e m em b er s; lif e st or y n ar r at iv es t h r ou g h clay, d r aw in g an d n ew sp ap er an d m ag azin e clip p in g s; inform ation exchange about each participant’s identity and feelings and exercises aim ed at greater obj ectivity and personal valuat ion.
The r esear cher s’ r eflect ion and act ion w er e su p p o r t ed b y l i t er at u r e ab o u t t h e t h em e, ab o u t p sy ch od r am a an d d r am a g r ou p s( 1 1 - 1 4 ), an d ab ou t
NLP( 12- 13). They also part icipat ed in psychodram a and
NLP groups.
The research group recorded, transcribed and an aly zed all assessm en t s of t h e r esear ch an d t h e w om en’s groups, so as t o avoid dist ort ions of t heir discourse and to allow each group to correct m istakes and m ut ually agree about differences. Focus groups se ssi o n s w e r e h e l d w i t h p r o f e ssi o n a l s f r o m t h e Wom en’s Support House Dom ingos Deláscio, involved i n ca r e f o r t h e se w o m e n . Th e si t u a t i o n s w e r e d escr i b ed , r eed i t ed an d an al y zed , b ased o n t h e analyt ic fram ew ork t hat w as pre- est ablished by t he researchers, starting from the answers that em erged. Nex t , t he life st or ies w er e r et old t o or der t hem in accor dance w it h t he analyt ic fr am ew or k cat egor ies, but m aintaining the characteristics of each life story’s cont ent s.
We at t em pt ed t o underst and t he sim ilarit ies an d dif f er en ces am on g t h e w or k sh op par t icipan t s’ experiences by analyzing t heir life st ories, based on t he or ganizat ion of t he par t icipant ’s ex per ience by m eans of live t est im onies( 15). I n line wit h an int ernal
logic t hat answers t he m ain research quest ions, we used the participants’ key words, which allowed us to est ablish connect ions in t he st udied process, in t his case low self- est eem .
RESULTS
About t he wom en
at t ent ion nor show ing sensual m anifest at ions. I t is rem arkable t hat m ost of t hem had a clear skin and long, dark hair, which was unt ied on t he occasion of t he rape; t hey were com m on girls who worked and/ or studied. One of them had a light m ental im pairm ent. The NLP exercises helped t he part icipant s t o t alk about w hat and sit uat ions t hat bot her ed t hem and, t hus, face unreport ed aspect s, coping wit h and m inim izing pr oblem s inst ead of fleeing fr om t hem . Som e feelings can be highlight ed, w hich ar e list ed below t oget her wit h t he st at em ent s, for t he sake of bet t er cont ent analysis:
- Repugnance, fear and t he fruit of rape
Aft er t he whole t raum a t hey suffered in t he rape situation, the second big threat, besides the fear involved in t he sit uat ion it self and t he probabilit y of cat ching diseases, is t he fear of having generat ed a child - fruit of t he t raum at ic event , who will not be considered as a child but as som et hing t hat always rem inds and reinforces t he aggression, t he feeling of im pot ence and r epugnance t ow ar ds t he aggr essor, as w ell as any obj ect t hat can r em ind t hem of t he fact . This is illust rat ed by t he following st at em ent s:
... I panic each t im e I ’m going t o t est for HI V. ... Thanks God I didn’t get pregnant , because I couldn’t st and bearing t hat t hing.
... I felt such repugnance of m y clot hes t hat I t hrew t hem away.
- I m age and place
Like in any traum a situation, and in rape cases in particular, som e detail is associated with the scene, which the victim ’s m ind starts to rej ect in other persons, on other occasions, in other places, and which usually becom es difficult t o ident ify and m inim ize w it hout t echnical help:
... I am horrified by t all and dark m en. ... I can’t see any m an wearing a checked shirt . ... I can’t see a gardener ( in t he condom inium where she lives, people inform ed t he aut hor of t he rape was a gardener) . ... I always at t em pt t o pay at t ent ion when I ’m at t he bus st op. I look around m e, not icing anybody who’s approaching. ... I walk in t he m iddle of t he st reet , I don’t walk close t o t he wall anym ore because t here can be a gat e and t hey can drag m e in.
The victim s tend to generalize, using universal quant ifiers like “ all” and “ always” in t heir narrat ives,
which should and can be discussed in order to rem ain lim it ed t o t he sit uat ion t hey experienced( 13).
- Fear of death
Fe a r o f d e a t h i s u n d o u b t e d l y t h e m a i n responsible for raped wom en’s lack of react ion, and is also t he sit uat ion t hat m ost rem inds t hem of t he aggression. Fear can inhibit reactions that could even avoid t he violence t hey suffered( 16).
... it was horrible: that m an held m e and was threatening m e all t he t im e wit h a knife.
... I w as ret urning hom e, w hen he caught m y arm , t hreat ened m e wit h t he knife and dragged m e ont o an em pt y piece of land.
- The pleasure of revenge
This really constitutes a key to work with the traum a of rape: in general, the wom en even revealed a cert ain degree of sat isfact ion when t hey found out about how the rapist ended up.
... t he prot ect or of m y com m unit y said he has already m ade t he guy disappear.
... I was relieved when I went t o t he police t o file a com plaint and t he policem an said: if we cat ch him , he dies.
- Support and Solidarit y
Th e v i ct i m s w e r e t o u ch e d b y t h e d e m o n st r a t i o n s o f su p p o r t a n d so l i d a r i t y t h e y r eceiv ed , an d d em on st r at ed t h at t h ey st ar t ed t o at t ribut e great er value t o people’s posit ive at t it udes t owards t hem( 3):
... m y fat her is really busy, but aft er I t old him , he used t o leave t he office earlier and spend t he aft ernoons wit h m e, holding m y hand and saying: you can sleep because I ’m here. That was t he best t hing t hat could happen t o m e.
...when I got t he t est result s and everyt hing was fine, it was very good and, wit h t he help of m y “ kit t y” ( boyfriend) , I m anaged t o overcom e t he crisis, t he revolt and t he depression I felt .
... each sm ile, each word MO said ( recept ionist at t he Wom en ’s Su ppor t Hou se Dr . Dom in gos Deláscio) w as v er y im port ant at t he m om ent of anguish and t raum a, it was t he m ost com fort ing and rem arkable, not only for m e, but for all ot her girls who arrived here t o find help.
m ost significant for ces of psy chological, social and spirit ual awakening and evolut ion. The way we deal wit h t raum a st rongly influences our qualit y of life.
The final report also m entions the im portance of adequate welcom ing to wom en victim s of violence, which again j ustifies the relevance of including health p r o f essi o n al s w h o d el i v er car e t o v i ct i m s i n t h e workshops, as a way of creat ing awareness.
- Rape at hom e
I n on e of t h e v iolen ce cases cau sed by a relative, the young wom an expressed the feeling that t h e f am ily con sid er ed h er as g u ilt y, b ecau se sh e provoked t he individual. I n t his case, im proving self-esteem required harder and at the sam e tim e delicate w or k , as fam ily suppor t w as not av ailable, on t he opposit e. Overcom ing t he t raum a was addressed as a ch a l l en g e. Besi d es b ei n g v u l n er a b l e t o st r eet violence in general, wom en suffer dom estic oppression and are often victim s of hidden aggression, m olestation and/ or abuse by relat ives and friends. This does not only cause t r aum a, but can cont inue for y ear s and also leaves doubt about guilt( 1).
- Bad care delivery
Un f o r t u n a t e l y, m o st h o sp i t a l s a n d professionals are not prepared yet t o deliver care t o t hese pat ient s:
... t here was anot her rape in t he care room . I st ayed on a bed in t he corridor, crying, all hurt and sore, and t he doct or cam e wit h t hat t hing ( speculum ) and she said st ay st ill because I need t o exam ine you and collect t est m at erial.
D o m e st i c a n d / o r se x u a l v i o l e n ce , em phasizing r ape as a const ant in all cult ur es and display ing higher incidence lev els w hen r elat ed t o abu se of alcoh ol an d ot h er dr u gs( 1 ), con f r on t s all
professionals involved with the challenge of recreating t he language of healt h, redim ensioning t he space of the disease and people, each of whom lives her story in different cont ext s, w it h different needs, but w it h equal right s t o express t heir opinion about t he way
t hey want t o be t reat ed and helped in t he sit uat ion t hey ex per ienced.
About t he workshops
The workshops revealed t hat t hese wom en, lik e u n der gr adu at e n u r sin g st u den t s in an ear lier st udy( 3), r esponded t o ex per iences at t heir hom es,
caused by brothers, fathers and people for whom they h ad felt affect ion an d adm ir at ion in ch ildh ood, by m eans of low self- est eem . They evidenced negat ive m em ories about t he violence t hey had suffered.
We o b se r v e d t h a t u n d e r st a n d i n g a n d accept ance by boy fr iends, husbands, par t ner s and t he w hole fam ily suppor t m ade it easier for t hese w om en t o recover t heir norm al life and reconst ruct t heir self- est eem .
I n d i v i d u a l e v a l u a t i o n s i n d i ca t e d t h e w o r k sh o p s a s a n o p p o r t u n i t y t o r ef l ect , ch a n g e at t it u d es an d p er ceiv e n ew r oad s ah ead . I n ou r opinion, one of t he posit ive point s in t his st udy was t he opport unit y t o prepare t hree wom en at t ended at t h e Wom en ’s Healt h Hou se of São Pau lo Fed er al Universit y, who were m ot ivat ed t o m ult iply t he self-est eem workshops in t heir com m unit ies.
The m ost noticeable situation in the group of em ployees was one professional’s st at em ent , during one of t he sessions, r ev ealing t hat she had ask ed t r ansfer ence t o anot her ser v ice because she could not st and so m uch suffering anym ore. I n response, t he wom en who part icipat ed in t he groups opposed her at t it ude and convinced her of her im port ance t o w e l co m e t h e v i ct i m s a t t h e Ho u se , a t su ch a discouraging t im e.
We believ e t hat t his r esear ch and t he self-est eem w o r k sh o p s sh o u l d co n t i n u e, i n o r d er t o im prove t he self- est eem assessm ent m et hod before and after each cycle, i.e. in term s of “ m inim izing the p h an t om ” of t h e r ap e sit u at ion , b esid es of f er in g support to other support groups for wom en victim s of v iolence, as a w ay of helping t hem t o bet t er cope w it h t he sit uat ion and also as a w ay of pr epar ing professionals who deliver care t o t hese wom en.
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