Dr. Jean on the challenges of mental health care in a rural area (part 8)

Dr. Jean knows from many sides the challenges of offering mental health care in the country, where resources can be strained. 

She also knows the challenges someone may face when they are living with abuse in a rural area — and leaving that situation may bring greater risk, even with the resources available through the Elizabeth Freeman Center and related places, and finding safety and protection may have challenges.

Kate: (Pauses and looks around the group, giving space for anyone who wants to ask more. Everyone is listening, and she goes on.) Sarah and I, we were talking some about resources we have in the Berkshires, and also (01:11:30) are there resources we need in the Berkshires? Because this is a rural area, are there challenges? 

Dr. Jean: When it comes to rural areas, there are always challenges to resources, just because of the limited amount of people and the limited amount of funds. So a lot of people aren't paying the amount of taxes that they do in other places, and it’s the taxes that fund the resources. 

And so, you know, we have one domestic violence and sexual assault agency here in the Berkshires. The county runs from Vermont to Connecticut. Yeah, we try to provide the supports.

But I mean, there has to be — because we know that when it comes to sexual assault, more people need services than are reporting the issue for services. So what that means is, it may look like there's nobody who need those services, so we would need three rape crisis center, about, we know that in rural areas, people are abused more — and they report less. 

So the incidents that we hear about, people just don't talk about. And we know also that most of the people who cause sexual assault or abuse, the harmers, is the proper term, the harmers are not (she indicates they are not being named or caught or stopped). People are not telling. A lot of sexual abuse has gone unreported. (01:13:00)

So that means those people are not supported, because you have to report to be able to get some help. You have to tell somebody what happened to you before they will help you. I mean, we have rape crisis hotlines. 

We have RAIN that people could just reach out to and get help anonymously, but I don't know if they're doing that so much as they should. 

So the resources, yeah, we probably could get more if we could prove that we need that, but we can't prove that we need that, because people are not reporting the incidents. 

Kate: So there's a higher rate of harm in rural areas? 

Dr. Jean: Of sexual abuse. Yeah. Well, you think about that. What do people do with their time? 

Kate: Are there practical challenges in protecting someone? … In a rural place like the Berkshires, even if you can come to a place like the Elizabeth Freeman shelter, (someone may be at risk any time they go out.) 

When you go to Stop and Shop — there may be limited number of places that you can go to do things like get groceries. And so the chance of running into the person you are trying desperately not to — 

Dr. Jean: It's very high. So, well, I think we live in an age now where we can get groceries delivered to us …. but it's expensive, and I want the pleasure of picking up my own groceries. 

So then you become isolated if you report. There's so many reasons, so many challenges, so many barriers to reporting. Because most of the people who commit sexual assault, sexual violence, are family members. They're people you know. They're acquaintances. They're not some guy hiding behind a bush. 

So when you report, if you think of the effects of that, it could cause problems in a family. Sometimes a person who's doing it (causing harm) is a breadwinner. (And if you report the harm) you take the breadwinner out of the house. 

Sometimes it's somebody who everybody knows. So you know what happens when everybody knows that person, that's “a wonderful person in our community” —you know what happens? You're not believed. You're not believed. 

So it’s complex. And like I say, How many places do you go for whatever you need? You will run into people that you know.
 
Kate: Or it may just be how do I know that if I leave I can be safe. How do I know that the person I'm trying to get away to me from won't be able to find me? 

Dr. Jean: Well with that we have a really good complex System throughout the United States, Puerto Rico and Hawaii You can get sent that far But most people don't want to go because you know what happened why you wouldn't want to go that far? You don't have a support system. 

Kate: Yeah. 

Dr. Jean: You'll be away from every you know everyone you knew. When I fled here 30 years ago, I knew (I would be leaving people I knew). And I didn't even know the way. I got lost. I ended up in Deerfield — not even realizing that five years from that my daughter would be entering Deerfield Academy. We got lost coming that way. 

Yeah, so I leave my family, my house, everything — most people can't do that. And for a sexual assault? some people say they'll do that for domestic violence, but for sexual assault, it’s been minimized. It's really — or you get blamed. “What were you wearing? What were you in? Why were you where you are? Why do you entice him? Why did you do that?” 

I'm just standing at the sink washing dishes and your husband comes and touches me, how I was it my fault? Oh, “because you have a nice shape” — how is that your fault? And then you begin to feel guilt and shame for something you didn't do. God made you. 

And so in many families, that comes out, and the person still stays with the abuser, with the harmer, because they have children, they have mortgages. (01:17:00) They have — I think a lot of times the person who has been harmed just keeps quiet because it creates less problems. 

Because most of the people sexually assaulted, the harmers are in the family, or they're in the community, or people you know. And there are so many different forms of sexual violence. Someone could say something to you, or someone could touch you. 

Someone could harass you, someone could force you to watch porn, (01:17:30) somebody could — all the way from saying something to you to physically raping you. It's all sexual assault. 

So until it's something really physical and really bad, some people just put up with it. You know, “you forced me to watch porn, you forced me to perform certain kinds of sexual — until it's an orifice being penetrated, most people just — (She indicates in gestures and tone of taut sadness that people often don’t recognize or name a harmbul behavior, or pattern of behavior, as assault. many people will live with it day to day and think they can’t just leave). (01:18:00) And then they suffer. 

There's a big consequence to sexual assault in our society, because a lot of times people become depressed. They may become traumatized. When you’re traumatized, you really can't function, until you get that kind of help that you need. 

So then you're not working. You’re not enjoying life. All these things are happening to you, as a result of that trauma. So the people experiencing sexual abuse, a lot of times they just stay quiet because it seems to make an easier life, but it's not okay. 

Kate: It may also be — I think it's fairly common for someone who's in that kind of harmful relationship that they often don't have resources because the person causing harm doesn't want them to have resources enough to leave. 

Dr. Jean: That’s the isolation. 

Kate: So they're saying ‘well, if I leave this state I'll lose my benefits,’ or ‘the only thing that's keeping me going right now is my group of friends.’ 

Dr. Jean: My family, my church, my organizations. (nodding) If I leave —? So then that's the reason why a lot of tons and the more rural the area is you'll see the bigger problem that comes because what do you do? Especially if you're not financially stable yourself.

Dr. Jean turns to the BRIDGE community who have joined us, opening space and time for their thoughts.

Rosa: (01:19:20) So, what about the disabled people? 

Dr. Jean: Yes. And twhere are they going to go? And they get abused a lot. There's a lot of higher incidents of them, because sometimes if you're physically disabled or mentally disabled, or maybe not mentally, but they have developmental disabilities. 

A lot of times there's a correlation of people who have — I mean, sometimes people with developmental disabilities are hypersexual, so they may come on to somebody thinking they have consent. They don't have consent because a person's body is ruling them. 
So if you're a decent human being, you leave them alone. But some people will take advantage of them. So there's a high percentage of people with disability, any kind of disability, that's also sexually abused. 

Rosa: And also, people who are not right in their mind? 

Yeah, that happens a lot because like I said, you know, sometimes it's that they want friendship, so they're looking for friendship, and somebody takes advantage of them. 

Now all those marginalized groups that we think of, there's a lot. Because people control people through sex. You can control somebody in that way. “If you don't have sex with me, I'm going to tell everybody what you do in bed. If you don't have sex with me, I'm going to do this. If you don't have sex with me, I'm going to do that.” 

That becomes controlling, and the person may just let them do it to get it over with. So it seemed like it's consent, but it's not consent, it's direct. (01:21:15)

She checks with everyone on time and their comfort.

Dr. Jean: I want to make sure that everybody has a chance to ask questions, because they've been here all evening with Rosa and everything. 

Laura: Just to say, in our culture, it's very common, the assault. Yes. And all the time, most of the time, the women are (told they are) the bad person. Yeah, you get blamed — the women get blamed for it. (People say) 'You can do this,' or 'this is what you have to do.' 

She explains that women are made to accept sexual assault and casual abuse — they are told that men are allowed to do anything they want to do, and women have no choices.

Nobody helps you. It's not a big problem. (They say) it's normal — it's normal. No, it's not. It's just so bad, but nobody helps you. If you go to the police station, nothing. (No one says) 'It's very bad,' or 'they can't touch you.' 

Yeah, like that. In Mexico, in my country, it's very common. And you're so sad, because it's not good. It's not nice. 

Dr. Jean: It doesn't feel good. 

Rosa: Yeah, and also I hear the news in Mexico right now, the politicians lower the age to consent. 

Rosa: Yes. That is another problem that we are coming with. They are practically adopting, the abusers, to abuse --

Dr. Jean: — the younger children. Younger and younger. Do you know what the age is? 

Rosa: 17. 

The conversation here moves into confidential spaces and then returns more generally. 

Dr. Jean: ... (01:35:20) That's when it's about resources. Yeah. The family (puts) all that burden on a 17 year old. You mean when you marry me up at 17, I'm supposed to save the family. And then they lower the age — it's like the whole world is changing right before our eyes 

That's 17 years old. What kind of wife can a 17 year old be? 

Kate: That's part of what I was thinking earlier, about where does the healing start? How do we learn again to feel confident in our own bodies? How do we learn to feel safe? How do we learn to feel our bodies belong to us? 

Dr. Jean: Again, the healing comes from ... (reclaiming) what someone took from us. Being able to begin to speak about it. And that means to remember and be able to speak about it when you can, at your own rate. 

Because some people are not ready to tell their whole story. They want to say something or they want to build a relationship so they can feel safe and secure and trust you before they tell you their deepest, darkest secret. 

Kate: Being able to say something and feel like people are listening. Taking it in. 

Dr. Jean: Right. That they care, and they're listening. (So you feel that) It matters. I matter. And we encourage you not to make you feel any judgment, feel any shame. (01:37:00)

Because in the past comes this (kind of blame) — "Well, why did you wear that dress?" The difference isn't made. It's my dress, I can wear it. Nobody should sexually assault me because I'm wearing a dress. But in certain places, as we said earlier, in the culture, they encourage that sort of stuff. There's no punishment for it. 

You say somebody's a rapist, and he's married and he's a president and he's married and people running all around. He's a rapist, right? So in certain cultures it's encouraged. 


I mean in America we do have laws — in the state of Massachusetts, you will get in trouble for raping someone — but you have to prove it. And the proof has been on the person who was sexually assaulted, to prove that that person sexually assault them. 


Rosa: Yeah, and when they try to get a proof or test, the victim that has also, that experience can embarrass them, when they try to catch a sample. 


The rape kit, a lot of people leave, they don't finish it. They don't do it, they don't want to go through it, they find it humiliating to do the rape kit. And then what do they do with the rape kits?


Most of them are just sitting someplace, nobody's being prosecuted. That justice, you know, you don't get that justice because nothing happens.


And I think they don't realize (the authorities, the people who stay silent or refuse to act)  that sexual assault is like a soul stealer. It takes a part of you, because it takes your control. It takes away from you trusting other people. ...

Kate: So how do we help each other to regrow our own souls? 

Dr. Jean: So besides the healing — maybe it's a part of the healing, to get your power back, to get your sense of feeling strong.

What is it that you feel that you can do to help others? That's how I took my power back. I said okay, I'm going to do this work. I'm going to help others to be safe. I'm going to help other children too.

(You need to) make sure the children get therapy, make sure you're taking care of them, so they can incorporate this memory into their life, and not just keep it over there as something that makes them sick from thinking about it or prevent them from doing things because they don't want people to find out, oh, my dad abused my mom, or oh, you know, this something happened to me. 

(01:41:00) So how do we, what's another step to be able to take action. And what kind of action can you take? I'm going to come here, and I'm going to talk about it. 

I'm able to, in some way, say something, speak to a school, do something, speak to young children and encourage other mothers to make sure your child is safe, make sure you're listening to them, make sure you listen to what they say.

 A lot of sexual, especially young girls and family stuff, people were never believed, because I think unconsciously people don't want to break up their family. It's easy to report a stranger or somebody you don't know, but for people that you know, many people just live with it. 

You hear these stories until you're like, "Wow." 

Kate: (01:42:00) It's part of why finding ways to empower people feels so important. To give people space and time. 

Dr. Jean: Absolutely. No, no, no, it's not easy, but ... (To everyone who has made and shared a place of trust tonight) Thanks for trusting us. Thanks for sharing with us.