As an intern in 1984, one of my first patients was a woman I’ll call Emily. Soft-spoken, with a wide smile and light brown hair, she was in her mid forties, from rural North Carolina. She’d had intractable headaches for decades. Despite extensive medical workups, no cause had been found.
I was working with attending physicians, studying the emerging field of wholistic medicine. Their patients had medical issues, but also concomitant anxiety and/or depression.
When I first met with Emily, she was kind, but reserved. She answered my questions about her health politely, a Southern girl wanting to please. “What makes it better? What makes it worse?” I took the medical history, a family history looking for diabetes, cancer and heart disease. As a psychiatrist in training, I also asked about her depression, her sleep, appetite and mood. Her family history was unremarkable; she was happily married with two children.
As I met with her daily, learning more about her, I was also reading the newly emerging field of sexual trauma. Freud and psychoanalysis had impacted psychiatry profoundly for years. Women were labeled “hysterical,” or fabricating, if they spoke of sexual trauma.
One day, I asked Emily a question no one else had. “Has anyone approached you sexually in a way that made you feel uncomfortable?”
The look on her face was stunned. Then, she spoke, slowly, haltingly, gazing at the floor.
“It was my wedding day. My pastor said we should talk before I got married, for premarital counseling. He picked me up that morning at my parents’ home. He drove me to a wooded area outside of town and he . . .” She paused, then began to sob. “He told me I should know what sex was like before I got married.” She looked up, horror and shame on her face. “I’ve never told anyone. I thought it was normal, that he was right. But I didn’t want that.”
My heart racing, I looked at Emily with compassion. This hadn’t been mentioned in medical school or psychiatry training. I remember thinking, “No wonder she has headaches, with this inside.”
“I am so sorry,” I said. “It doesn’t seem right, at all. You must have felt so alone.” She nodded, tears still staining her face, then turned her head away. “I think I’d like to rest now,” she said quietly.
Durham, North Carolina