“From the El Paso-based indie publisher, Cinco Puntos Press. Writers talk with each other about their books. This episodes features Sonia Patel, author of BLOODY SEOUL, chatting with Jacqueline Briggs Martin and June Jo Lee, co-authors of CHEF ROY CHOI AND THE STREET FOOD REMIX from Readers To Eaters. They had a wonderful conversation about the connection and comfort food can bring us, the concept of sohn maash in Korean culture, why we should make the world bigger instead of trying to fit in, and many more great things!”
Yup, I live by those lyrics in my work as a child, adolescent, and adult psychiatrist. Let me explain.
Behavior is often driven by unconscious triggers, feelings, and biases (race, gender, etc.). When people behave without awareness of what they are doing and/or why they are doing it, their actions and choices can leave them isolated, caught up in anxiety, depression, or other mental health difficulties, and unable to form meaningful relationships. My job is to help patients become self-aware of their unconscious behaviors and biases so they can “live their best lives.” Often these unconscious behaviors and biases are linked to their past experiences (with family, environment, etc.).
Interestingly though, it’s not uncommon for some patients to consciously behave in negative ways towards me, but lack understanding about why they’re doing it. Here are some examples:
Not showing up to scheduled appointments
Not paying copays on time, or at all, when they possess the financial means
Wanting to be friends
Attending appointments high or drunk
Expecting or demanding that I fill out forms that are not medically necessary
Expecting or demanding that I prescribe medications that are not medically appropriate
Not attempting or following through on treatment recommendations but then expecting or demanding that I do what they say when they say it
Making subtle misogynistic, racist, or belittling comments
It’s difficult to withstand these types of behaviors sometimes, and I’m not perfect, but I understand the psychological link between maintaining strict boundaries and patient improvement. I understand the importance of turning misbehavior towards me into therapeutic gains for patients because the goal of therapy is to not need it anymore. If patients are willing to work with me on getting through the strict boundaries I set forth, and trying to change their behavior towards me, then we can explore the unconscious reasons that motivated them to do so in the first place. And that is where the money’s at. You see, that psychotherapeutic work can lead to increased self-awareness and lifelong improvements in self-worth, decision-making, and relationships.
I appreciate this review by a strong advocate of diverse children’s books…
by Sonia Patel
Cinco Puntos Press, 276 Pages
reviewed by Kristie Gadson
To Rocky, the city of Seoul is truly something to behold. Sprawling skyscrapers dare to kiss the sky, thousands of lights rival the sun at night, and millions of people bustle through at any given moment, while the Han River remains a calm force through it all. And it will soon be his to rule, just like his father, the leader of the city’s most notorious gang, Three Star Pa.
However, despite Rocky being the sole heir and next in line to become the big boss, his father refuses to turn the gang over to him. Frustrated, Rocky isn’t entirely surprised. It’s one of too many unanswered questions that plague him, especially since his mother’s faded memory threatens to slice the edges of his own mind like a knife.
Sixteen times, one for every year of my life.
Ten times, one for every year mom’s been gone.
Ten times, one for every year Dad’s been the most pissed off person I’ve ever known.
In Sonia Patel’s poetic, fast-paced and electrifying second novel Bloody Seoul, the thread of Rocky’s past unravels the life he has carefully planned. Molding his life to mirror his father’s, he leads his own Three Star Pa gang made up of his closest friends. He beats up his weaker classmates, fist fights to defend his turf against rival gangs, and torments Ha-Na, a mixed Korean and Indian girl whom he regards as an easy target. Rocky’s life is structured to form the future he desires; but his mind frequently dives into the pool of reverie, where the ghost of his missing mother beckons and the needles of his fractured family sting.
What makes Rocky’s story so tangible is how Patel invokes memory and stitches it throughout the first-person narrative. Rocky’s past comes forth by means of his senses: he sees a family photo and remembers a time when his father was happy, he feels his mother’s love within the careful stitch work of the handkerchief he keeps, and smells her scent when he smokes her favorite brand of cigarettes. He also hears her humming when he plays his favorite songs and feels the presence of his uncles when he eats their favorite dishes. Memory is naturally triggered by the five senses, and Patel uses these to further develop Rocky’s character and have us connect with him.
The memories of his past reveal many open wounds, forcing Rocky to confront his father about what really happened to his uncles, his mother, and their family. But his father answers Rocky’s questions with threats and bruises, a direct violation of the first code of Three Star Pa: Family comes first. Family is to be protected at all costs. His father’s blatant disregard of that code forces Rocky to realize his father’s true nature and the lengths his father will go to get what he wants.
There are many ways I’m like my dad, many ways I want to be like my dad, but killing people isn’t one of them.
Patel’s writing shines. Her words flow across the page like a poem – descriptive yet succinct, observant of an entire world in so few phrases. Her writing style reflects Rocky’s character. It is observant, wastes no time equivocating, and takes everything in while focusing on what’s most important with sharp precision. The language may seem shallow at first – like Rocky’s perception of his own life and goals – but the more Rocky plunges into his memories, the deeper the language pulls readers in.
Patel explores how the interconnectivity of memory and family shapes one’s identity. Rocky’s identity is hugely shaped by his relation to his father and Three Star Pa, which had always remained unchallenged. Memories of his past and, most importantly, of his mother undermine this identity, causing it to crack and break. His journey toward redefining himself is a difficult one that readers can relate to. Who are we if not an extension of our family? When memories of a difficult past cause us to break away from our families, how do we go about defining ourselves without them? And who do we let in to our chosen family?
To these questions, Rocky learns there is no easy answer. Discovering who we are is simply that: discovery. And there is no end to it. It’s a journey with no set destination, and in the face of hardship all we can do – all we must do – is keep moving forward. Bloody Seoul teaches us this lesson through colorful and subtly powerful storytelling, gripping readers from beginning to end. A one-of-a-kind read.
New life just around the bend.
More happiness than I can comprehend.
Kristie Gadson is a recent graduate of the University of Pennsylvania with a Bachelor’s in English. But, formalities aside, she knew that children’s books would become her passion when she found herself sneaking into the children’s section of Barnes & Noble well after she turned eighteen. She is a strong advocate for diverse children’s books, and writes diverse children’s book reviews on her blog The Black Sheep Book Review.
MY CONTRIBUTION OF THE DAY: A PROCLAMATION TO PUSH THE BOUNDARIES OF WHAT IS SEEN AS DIVERSE IN YA FICTION.
DEAR YA FICTION, NOT ALL DIVERSE TEENS CELEBRATE THEIR CULTURE(S)
By: Sonia Patel
In June, my husband and I took our two half Filipino-half Indian teenagers and their three half Filipino-half white cousins to a Little Simz concert in Chicago. Little Simz, a black rapper from England, delivered nothing less than powerful, feminist bars. Her inspiring lyrics seemed to light up Lincoln Hall’s dimness and hypnotize the eager crowd. My family and I head nodded, deep in the zone. And when Little Simz spit the words “the Philippines” in a hook, our kids, nephews, and niece exploded with pride, their fists thumping their chests then pumping high over their heads. I stood behind pressing my hand on my heart and smiling, overcome with a mix of awe and happiness for them. But then a thin layer of sweat formed on the small of my back. I peeled my shirt as guilt and grief took turns trying to tug the corners of my lips down.
Why can’t you be that proud of being Indian?
You know why.
Sure, but it’s not like you’ve ever been starving or had acid thrown on your face so get over yourself.
But things were bad in a different way.
I don’t celebrate my Indian culture. I never have. I don’t know how to because I was raised around it, not in it. Growing up, it was as if I was an outsider sitting in a dark theater watching our Indian relatives and family friends on the big screen like a Bollywood film. I studied the intricacies of my mom and grandmother’s daily Hindu worship of Thakorji. I noticed the way my mom lent a helpful ear and hand to everyone, despite some of her in-laws putting her down. I plopped down on the sofa next to my mom when she was engrossed in one of her pirated Indian movies depicting perfect, loving families. I was fascinated by the beautiful, intricate saris and gold and diamond jewelry Indian ladies wore to weddings and garba...the delicious, complicated food my mom and aunties made......the emphasis on hard work and education...the sacrifice to help my generation make it in America….
Still I didn’t feel Indian. I felt worthless. What no one knew was that at home, my family’s way of life, our secret culture, was that of isolation, conflict, and abuse.
Now as an adult I recognize the elements of patriarchy, misogyny, and intolerance long present on one side of our extended Gujju network but the culture of dysfunction (COD) at home was its own terrible beast. Simply put, my dad was a charming tyrant. My role was his wife. My mom was his servant. My mom and I existed, voiceless, to accomodate my dad in every way.
Instead of getting a shot at normal teen emotional development, I was in a perpetual state of anxiety to keep the peace at home, and then in my future relationships, even if that meant making poor decisions. Instead of having the opportunity to build my separate identity and self-worth, I learned that my only value was in pleasing my dad, and then men like him who similarly lavished me with attention in exchange for my emotional and/or sexual usefulness. And instead of developing skills to maintain healthy, nuanced peer relationships, especially with girls, I didn’t trust anyone.
Looking back I’ve come to understand that my family’s COD trumped any protective effects of my Indian background. Why? Because the COD was the lens through which I saw everything Indian. And since there wasn’t a single day of my youth that I experienced my Indian-ness independent of the COD, the two became inextricably linked for me. Being Indian was foreign to me yet I equated it with pain.
I’m not alone. Many of the diverse teens I treat who live in COD don’t have strong connections to their birth culture(s) either. Let’s face it—COD is universal. In my office, when these teens reveal their agonizing stories of abuse, neglect, parental drug use, parental mental illness, and/or other severe adverse childhood experiences, their mental suffering is similar regardless of their backgrounds. It’s true that they may manifest some culturally specific variations in symptoms, but there are undeniable commonalities in their negative thoughts, feelings, and behaviors. That and the medically proven trauma-induced brain changes are the same.
In order for youth to survive traumatic experiences that are out of their control, dysfunction can become hardwired in their developing brains. They can become stuck in survivor mode as COD clouds their vision and becomes the blueprint for future relationships, leaving them prone to an endless cycle of repeating and recreating what they’ve endured at home with others. This is largely why the buffering effects of their birth culture(s), such as positive relationships with extended family members or participation in traditional activities and religious practices, can remain out of reach.
It’s crucial to understand that these diverse teens are often alienated from their backgrounds because they never experience it apart from their COD. They are shoved onto different playing fields of development far apart from teens being reared in healthy families where culture isn’t shrouded in toxicity. So to expect all teens, particularly those from cultures stereotyped as nerdy and family-oriented immigrants, to rise above their struggles is unrealistic. More likely these vulnerable teens living in COD may have extreme difficulty making friends. Or, they may choose another family of “bad kids.” They may not be able to set limits with people. They may engage in repeated risky, quick feel-good behaviors (sex, drugs, alcohol, etc.) not condoned by their birth culture(s).
Let’s take fifteen-year-old Kaya (not her real name), a part Native Hawaiian-Filipino-Japanese girl who I began treating recently. She wants to feel connected to her family’s blended way of life but can’t. She’s spent her youth battling recurrent negative thoughts, flashbacks, depression, suicidal thoughts, and worthlessness. Our talk therapy to this point has given her insight into why her neural circuitry hardwired with depression and anxiety—it allowed her to survive the abuse. Her symptoms told her that the abuse was her fault, thus giving her a sense of control in a situation that’s been totally out of her control. It’s my fault. I’m bad. I deserve it. Why else would the people who say they love me the most hurt me the most? Why else would the people who’ve taught me cultural values of family, respect, and honor treat me and each other like this? She wants to feel pride when her family participates in Native Hawaiian activism but ends up feeling disgust. Her profound emotional burdens have denied her the mental free time to be a “regular teen.” She hasn’t dreamt about her future or romance or hobbies or college or achievement or the next party. She can’t help but feel like an imposter at family gatherings and traditional ceremonies. She hasn’t had a fair chance to form strong female friendships. She hasn’t been able to set limits with boys—she’s allowed them to push her around and she hasn’t been able to say no to sex like she wants to. She also hasn’t been able to come out as lesbian though she identifies as one.
This brings me to YA fiction. Obviously teens read for different reasons. Some of my diverse teen patients enjoy escaping the hardships of their lives by immersing themselves in YA fantasy, dystopia, or paranormal. Some are drawn to YA romance. There are some, however, who seek to find themselves in books. But diverse teens being raised in COD have a difficult, if not impossible, time finding themselves in existing YA fiction. At this time most of it celebrates different cultures. Most of it includes at least one functional parent who protects against the occurrence of COD and therefore makes it possible for the birth culture(s) to be appreciated.
Kaya hasn’t found herself represented. How can she when COD has prevented her from experiencing her birth cultures without bias? How can she when she feels distant and, at the same time, repulsed by her birth cultures?
When I was Kaya’s age, I couldn’t find any Indian or Indian-American YA novels. There are some these days but I can’t relate to any of them. That’s one of the reasons I wrote Rani Patel In Full Effect. It’s why I decided to keep writing (Jaya and Rasa: A Love Story, Bloody Seoul, and a fourth YA novel in the works).
Teens living in the complex dynamics of COD may not be able to see themselves in diverse YA fiction, including realistic bestsellers, that happen to be by or about people of their same background. To think otherwise—from my point of view as a child and adolescent psychiatrist in the trenches with vulnerable teens—is short-sighted, minimizing, and insulting to those in the midst of survival and in the most need of empathy from sources outside of the family.
YA fiction needs to expand its boundaries beyond safe, popular stories that affirm and praise different cultures. It needs to push past the expectation that all diverse teens can conquer adversity in a tolerable way. It needs to depict the ugliness of when COD hijacks birth culture. It needs to represent the unpalatable perspectives of teens who don’t have the luxury of enjoying their cultures and working through typical teen concerns. It needs to embrace painful reality, not just what’s convenient. It needs to champion these types of troubling diverse stories the way it does those stories that make people feel comfortable, content, and less guilty. Afterall, the Kayas of the world are worth it even if they themselves can’t feel worth it yet.
I was Insta-famous and it was one of the worst things to happen in my 20s
BY: Verity Johnson
Modi was just re-elected as prime minister of India and Trump might be re-elected as president of the United States of America, things that make many of us shudder. I try my best to be open-minded but I can’t help but wonder why some of my brown-skinned Gujarati-Indian relatives are pro-Modi and/or pro-Trump. It’s shocking to me, but mostly sad. Especially when the relatives are women.
We’ve all heard about the hate of women that goes on behind the closed doors of some everyday families. Families where husbands beat wives. Families where uncles rape nieces. Families where daughters are sex trafficked. Families where sons take part in honor killings of their women relatives.
And as leaders of two big democracies, Modi and Trump don’t do much to end the hate of women. In fact they often perpetuate it in their lack of support for women’s issues and their bold declarations…
Trump: "If Hillary Clinton can't satisfy her husband, what makes her think she can satisfy America?”
Modi: At an election rally in Himachal Pradesh, said about Sunanda Pushkar (wife of politician Shashi Tharoor), “Have you ever seen a Rs 50-crore girlfriend?”
So do the leaders of other countries…
Bolsonaro: He said this about a fellow lawmaker in congress. “She’s not my type. I would never rape her. I’m not a rapist, but if I were, I wouldn’t rape her because she doesn’t deserve it.”
Kim Jong-Un’s government: The North called former South Korean President Park Geun-hye, the country’s first female leader, a prostitute.
Duterte: “They said there are many rape cases in Davao. As long as there are many beautiful women, there will be more rape cases.”
When misogyny is proclaimed and acted upon as truth by powerful male leaders, it hurts women by making them worthless objects instead of worthy humans. The effect is the same when misogyny is proclaimed and acted upon by any man—a husband, father, son, uncle, etc. The very nature of oppression can make women more likely to have blind faith in cruel leaders and men in general. Maybe that’s why some of my women relatives are pro-Modi and/or pro-Trump.
I remember the misogyny proclaimed and acted upon as truth in my Gujarati-Indian family of origin—husband/father is god. A euphemism for wife is servant, daughter is wife. Years of this crushed my mother’s soul. It left me hating myself and needing men to validate my existence. To survive we had to accept and recreate the object status give to us by “god”—have blind faith in a the husband/father.
Thankfully, my mother and I broke away from our traumatic past. But the scars will never disappear. That’s why I’m passionate about helping others heal through individual and family therapy. That and I’m dedicated to writing realistic young adult novels that depict the ramifications of misogyny on adolescent development.
Thinking out loud about the big picture, perhaps part of what can help change the existing cruel, misogynistic leadership plaguing our world is to start small scale: one vulnerable family at a time, change the dynamics of dysfunctional families from all walks of life. This is obviously complicated and would require multiple levels of resources, but it may just be the paradigm shift that is needed. I don’t have all the answers but imagine if abusive husbands learn and want to treat wives like the equals that they are. Or imagine if all fathers treat daughters with respect and teach sons by being good role models and all mothers had the privilege to teach daughters to use their voices and teach sons how to treat women. Imagine if there were no women who hated themselves or their situations. If that happened in every family, perhaps generational misogyny would end. Then, who would vote for Trump? Or Modi? Or any misogynistic bully?
At the end of the day, if we don’t help families heal when possible, then aren’t we allowing husbands in those families to play god? Aren’t we allowing Modi and Trump to each play the god of gods?
A local radio station has been touting all day about their contest that gives away free breast augmentation based on social media votes for “you and your best friend”—“breast friend”—courtesy of a cosmetic surgery clinic. As a child, adolescent, and adult psychiatrist, I’m here to tout fierce opposition to this contest.
I’m a feminist MD so I support women in making personal, informed decisions about their lives, including about abortion or going under the knife for breast augmentation. What I don’t support are the beauty and gender norms imposed on women by society, often patriarchy. And when a man’s voice proclaims to my teenagers and I on our morning commute how me and my best friend can win boob jobs based on how many likes we get on the radio station’s Instagram page, he’s really telling me that my friend and I are not good enough the way we are. Even if he doesn’t intend to send that message, it will be the lesson learned by some vulnerable people. It’s as if he’s telling your daughter, your sister, your niece, your mother, your student, your employee that she is not good enough the way she is.
Maybe I should thank the radio station and the cosmetic surgery clinic. I mean their degrading, damaging, misogynistic message will keep me in business. A majority of the young women and girls I treat are already scarred by social media comparisons, some of them rocked to core with how inadequate they feel every single time they scroll, and now you’re encouraging them to send in photos of themselves and their best friends so they can be judged online more than they already are. Only if they’re deemed worthy enough by a bunch of random people will they be qualified to get the look that is set forth by the western beauty myth.
But I will not thank you. I don’t want more business. I want a world where the young women and girls I treat will feel good enough just because they already are good enough. I want a world where women and girls will be encouraged to speak, disagree, earn, change policy, and be president. I want a world where my teenage daughter isn’t reduced to a body. I want a world where my teenage son isn’t bombarded with hyper-sexualized images and lyrics of women—and now, radio contest announcements that lure women to their very own best in show—that might train him to think of his future girlfriend as nothing more than an object were it not for the protective way my husband and I raise him.
I want a world where I can turn on the radio and no man will ever tell his listeners how women and girls can be better. Because here’s the truth—we already are.
I often assign homework to my teen patients as part of our ongoing talk therapy, because healing doesn’t just occur in the office. Sometimes the homework is writing. It can be a poem, or prose, or a letter. The format doesn’t matter as much as the eventual outcome-that writing can facilitate the processing of complex thoughts and emotions. Not only can writing lead to healing but it can be used as a positive coping strategy during difficult, triggering times in the future.
I practice what I preach. Here’s a poem I wrote this morning to help me resolve old wounds that opened up a little…
When it all fell apart
It was me, my heart
That was blamed
Tossed into the fires of women shamed
Yet I scratched and crawled, dragged
My soul up the jagged
Mountain of healing
Saved myself by kneeling
To insight, not your God
That daughters of narcissists
Are primed to exist
Solely as objects for abusive men
Cloaked in normalcy, again and again
She’s vulnerable to predators
Recreating traumatic metaphors
She reeks of selfish lies
Groomed, doomed, to repeat father-daughter highs
Four decades later I reached the mountain’s peak
And learned to speak,
Roar, because understanding is my dominion
I reject your ignorant opinions
Your blind accusations
Making my own declarations
I DON’T CARE WHAT YOU THINK.
I made this video for the Child Mind Institute. I’m grateful to be a part of their #myyoungerself project.
Published on Apr 20, 2019
Sonia Patel is a physician and author. Patel is psychiatrist in Oahu and is passionate about helping teens work through emotionl obstacles. She is also the author of several books including, "Rani Patel in Full Effect," and "Jaya and Rasa: A Love Story."
#MyYoungerSelf by Child Mind Institute is an anti-stigma campaign. We are grateful to Sonia for her willingness to open up about her childhood experience with anxiety and depression.
ABOUT CHILD MIND INSTITUTE As an independent, national nonprofit organization dedicated to transforming the lives of children and families struggling with mental health and learning disorders, we deliver the highest standards of care, advance the science of the developing brain, and empower parents, professionals, and policymakers to support children when and where they need it most.
While YA novels are increasingly diverse, safe diversity—with accessible and likable protagonists and their convenient struggles—is usually seen as enough. These unoffending books tend to be championed and more popular. Unsettling diversity, on the other hand, is often frowned upon, discounted, or misconceived.
I’m a practicing child and adolescent psychiatrist and a young adult novelist. To me, dismissing YA that’s outside the realm of palatable diversity is like a psychiatrist refusing to treat certain teen patients because they have “too many problems.”
I’ve spent over fifteen years treating diverse teens who suffer tremendous adversity—abuse of all kinds, neglect, parental mental illness or drug use, etc. Medical research proves that youth exposed to these types of adverse experiences have an increased incidence of chronic medical and mental health problems, increased risky behaviors, and less future success. That’s why I’m dedicated to being in the trenches with them, helping them dodge life’s bullets. Hoping to steer them to higher ground.
An example is in order.
Kai (not his real name), a seventeen-year-old Filipino-Hawaiian-Japanese-Korean boy, is sitting across from me, staring out the window. It’s been six months of almost weekly individual talk therapy sessions. I bring up the heavy family issue. Kai presses his lips together. Suddenly he shoots up, a scowl covering his usual poker face. He takes three steps to the large window and slams his head, three times. A pause then three more slams.
I call his name. He glances over his shoulder, his eyes moist. In a gentle voice, I ask, “Will you sit down or should I call the police to keep you safe like last time?”
He punches his head three times. “It hurts so much in here,” he angry whispers, tears now streaming.
“Let’s talk about it,” I suggest.
He glares at me but then sits. “Fine,” he mutters.
That was Kai’s breakthrough moment. It was the first time he spoke about a feeling instead of showing it with alarming behavior. It was the moment we started translating his behavioral language (obsessions, compulsions that were often harmful to himself, bullying, social isolation, alcohol use, and truancy) into English words.
Still, healing took years. Negative coping strategies had been automatically reinforced, and eventually hardwired, in his brain. New, positive brain pathways took time and work to form.
I have personal experience with this. You see I grew up in a dysfunctional Gujarati Indian immigrant family with dark secrets. The opposite of the typical Bollywood family depiction. I started writing to cope. It was poetry and rap at first. It turned into my debut young adult novel Rani Patel In Full Effect.
I struggled with how to portray Rani, my Indian-American main character. In the real way teen survivors of sexual abuse present to my office? Or in a sugar coated way with righteousness, fully formed feminist strength and insight, and flowery perfect prose to make her more appealing to readers?
I decided on real. Real meant raw and flawed. Real meant making her an uncomfortable protagonist. As a reader, you invest time caring about her. But Rani doesn’t have gorgeous words to describe the pain of her abuse, she speaks by recreating her role as an object for men to use and ends up making obviously bad decisions. You want to scream at her. That’s what it like supporting a person working to recover from trauma.
My next YA novel, Jaya and Rasa: A Love Story is based on amalgams of real teen patients. Sorry, but there’s nothing comfortable about walking in the shoes of a depressed, suicidal Indian-American trans boy and a sex trafficked mixed ethnicity girl.
My third YA novel, Bloody Seoul, will be released in July. The main character, Rocky is Korean and has aspects of Kai, other patients, and my imagination. If Rocky kept a journal, his abrupt sentences would reveal his brain’s ingrained survival reactions to the chaos of his mother’s abandonment and his father’s violence—a hard edge, limited empathy, emotional unavailability, and OCD behavior.
My fourth YA novel will follow suit. I can’t stop, won’t stop, introducing troubling protagonists because there are entire groups of diverse youth not yet represented.
YA lit needs to transcend safe diversity. It needs to be enthusiastically inclusive of disturbing realistic novels that purposefully miss the bull’s-eye of acceptability. Even when it’s really hard, we need to try to understand all teen protagonists who engage in incomprehensible behaviors. Even if we don’t agree, we need to try to empathize with them when they make upsetting choices. That is true tolerance. That is true diversity.
This essay was originally published in LENGUA LARGA, BOCA ABIERTA, edited by Isabel Quintero & Allyson Jeffredo, February 2017. I shared it on my blog soon after but took it down when I received threatening letters about the personal content.
The Unrecognized Impact of Sexual Violence on Survivors
by Sonia Patel
The truth of the matter is that “20 minutes of action” by men with privilege, power, and influence that “just kiss,” “grab ‘em by the p***y,” “don’t even wait,” and “can do anything,” can cause a lifetime of brain repercussions for their victims. And this is what is missing from the current discussion of sexual violence—that the effects on victims can be as biologically serious as brain injury induced by things such as concussions or crystal methamphetamine use.
As a child & adolescent psychiatrist, I’ve spent over twelve years guiding sexual violence survivors on their paths to recovery. I’m also a young adult novelist and my debut, Rani Patel In Full Effect, details the negative impact of paternal covert and overt incest and date rape on a sixteen-year-old girl. My second novel, Jaya and Rasa: A Love Story, addresses LGBTQ issues and one example of sex trafficking, including the profound damage that occurs to the development of a young girl when older men prey on her sexually from the time she’s twelve.
Sexual violence can damage a survivor’s brain at a cellular and physiological level. Time and time again medical research has shown that sexual violence can, for example, alter brain structure, change how the brain reacts to stimuli, deregulate neurophysiological interplay, and impair cognitive function. Children are particularly vulnerable to this devastation because their brains are still developing. These types of brain injuries can adversely alter everything about how children or adolescents approach and experience their life as they grow into adults. The normal development of their sense of trust, self-worth, ability to be assertive, and formation of their identity is thwarted. They are more likely to have pessimistic automatic thoughts, negative feelings, compulsive and self-destructive behaviors, and inability to maintain appropriate boundaries or form deep connections in relationships. Their brain injury might be expressed as one or more full blown psychiatric disorders.
Survivors may get lost in the cognitive and emotional manifestations of their impaired brain function. They may even accept that these symptoms are who they are instead of their brain’s unavoidable biologic response to the sexual violence.
Discussion of sexual violence is not typically encouraged and in fact society tends to at least partially blame the victim. In addition, because abusers put their own wants first and lack empathy (both of which can be hallmarks for serious psychiatric issues such as the Narcissistic Personality Disorder), their cavalier stance on the ramifications of their actions reinforces the view that the guilt rests with the victim. So survivors of sexual violence may suffer in silence. Stifled, they can’t focus on how harmful the abuse was. Rather, they are stuck in “speaking” and “living” through their troubled cognitions and emotions and end up in a vicious cycle of helplessness and shame that can lead to a lifetime of dangerous choices and various addictions, including drugs, alcohol, and sex.
Of course there are multiple factors that can alter the biological brain effects of sexual violence—chronicity of the abuse, genetic susceptibility, family and peer support, etc. But there is no doubt that sexual violence can change a victim’s brain functioning. Still, healing is possible. It takes time because it requires a survivor to essentially “retrain” their brain to think, feel, act, and connect with people in a positive way. I often tell my patients that depending on how many years they’ve lived with their dysfunctional brain wiring, it might take them that many years to fully recover. This is not to make them lose hope but rather to foster empathy for themselves about the severity of the abuse they suffered. Empathy for themselves, as it turns out, is an important part of gaining insight into their ordeal. And insight is the first step on the path to healing. As survivors gain insight into the sexual violence they suffered, they escape the muteness of their trauma and learn to find words to separate themselves and verbalize their brain’s biologically conditioned cognitions, emotions, behaviors, and connections to people. This leads to empowerment because they begin to realize they are not what their thoughts and feelings tell them. They become aware that they are worthy of being more than sexual objects for others. They figure out that they can reinvent themselves independent of the sexual violence they suffered.
And I should know. Because besides my medical training in the effects of sexual violence on patients and the years I’ve spent treating them, I’ve spent years individuating myself from my role as my father’s intimate object. I’ve thought the worst of myself. I’ve felt the depths of depression. I’ve hated myself and wanted to die. I had years of nightmares about being kidnapped and gang raped by older men. I’ve indulged in quick fix self-destructive behaviors and made impulsive, bad decisions that hurt me and those I loved.
Eventually I gained insight into my brain’s negative hardwiring and it became clear to me that I’d have to work hard to overcome the existing circuits. Many tears and years later I succeeded in creating new ways of thinking, feeling, behaving, and relating to people. My self-worth is solid and my boundaries and decision making much improved. I am my own person.
Given the recent revelations of sexual violence by many high-profile men in a wide range of industries, I am hopeful that we as a society can use this political moment and the conversation it has provoked to reshape our understanding of sexual violence. We can do this by fully supporting victims and survivors of sexual violence on their journey to recovery. We can do this by not standing for any of the excuses for unacceptable behavior thrown around by abusers. And we can do this by eliminating once and for all the disgrace surrounding victim status.
“Every year close to 800,000 people take their own life and there are many more people who attempt suicide. Every suicide is a tragedy that affects families, communities and entire countries and has long-lasting effects on the people left behind. Suicide occurs throughout the lifespan and was the second leading cause of death among 15–29-year-olds globally in 2016.
Suicide does not just occur in high-income countries, but is a global phenomenon in all regions of the world. In fact, over 79% of global suicides occurred in low- and middle-income countries in 2016.
Suicide is a serious public health problem; however, suicides are preventable with timely, evidence-based and often low-cost interventions. For national responses to be effective, a comprehensive multi sectoral suicide prevention strategy is needed.”
--World Health Organization Fact Sheet on Suicide 8.24.18 https://www.who.int/news-room/fact-sheets/detail/suicide
Yesterday, Keith Flint, the frontman for the band Prodigy, took his own life. He was 49. His suicide hit me hard. As hard as Chester Bennington’s, lead vocalist of Linkin Park who was 41. Being a first generation Gujarati Indian American, my life experiences didn’t align with theirs, but I found solace in their powerful music. As did many other people. That and I’m also in my 40’s. And I’ve had suicidal thoughts. The shit is real.
But I haven’t taken the thoughts to the next level—the attempt level or the deadly level.
How am I lucky enough not to have taken it to the next level when so many people have?
Maybe it’s because I’ve spent years in medical school and residency training studying trauma, depression, anxiety, and suicidal thoughts on a biologic level. Or maybe it’s because I’ve spent thousands of hours putting myself in the shoes of numerous youth and adults with suicidal thoughts and attempts and trying to help them survive. Or maybe it’s because I remind myself that I don’t want to hurt my husband and children. And I’m fortunate to not be abusing drugs or alcohol.
What I know for sure is that it isn’t easy because sometimes the suicidal thoughts are so intense, so real, so seemingly inescapable. Vivid swirls of GRAB THAT KITCHEN KNIFE AND STAB YOURSELF IN THE HEART…RUN INTO ONCOMING TRAFFIC…
See that’s what happens sometimes to people with hardwired anxiety and/or depression. The suicidal thoughts are SYMPTOMS of this hardwiring. The suicidal thoughts are not a character flaw. They are not a cop-out. Suicidal thoughts can be misguided, automatic thoughts aimed at exerting the ultimate control over overwhelming chaos.
A person with well-treated asthma isn’t in a constant state of an asthma attack, but can have symptoms such as wheezing when triggered by weather changes or exercise. In this type of case, breakthrough asthma symptoms can be treated quickly, allowing the person to return to normal functioning. Similarly, a person with well-treated anxiety and/or depression can have suicidal thoughts when triggered by tremendous stress, conflict, loss, reminders of painful pasts, etc. That’s how it is for me. I’m not in clinical depression or anxiety. But things can trigger symptoms. I’ve learned to manage these breakthrough symptoms immediately so that I can return to my normal, healthy baseline in no time. If the breakthrough symptoms include suicidal thoughts, I remind myself that my brain is playing tricks on me because I’m overwhelmed. I tell myself to listen to music instead, it will pass. Or I tell myself to write, it will pass. Or maybe take a nap, it will pass. Cry if needed, it will pass. Go for a hard run, it will pass. Ask for a hug and reassurance, it will pass. Now is not the right time for the glass of cabernet, it will pass. I repeat the mantra IT WILL PASS.
And it does.
But the breakthrough symptoms, including suicidal thoughts, may come back because that’s how my brain is wired to automatically handle massive stress and I understand that. But I’ve got an arsenal of coping strategies at the ready to help me pull through no matter how many times symptoms such as suicidal thoughts breakthrough.
If you are depressed or have suicidal thoughts, please call the National Suicide Prevention Hotline 1-800-273-8255. https://suicidepreventionlifeline.org/
I’m passionate about providing psychiatric treatment to diverse teens who are struggling through various hardships. Along the way, these teens make poor choices in relationships and in self-care because that’s how real life often plays out when youth are raised in chaos. It’s important to me that their imperfect journeys aren’t dismissed. That’s why I’m also dedicated to translating their struggles into realistic young adult fiction that isn’t written to please but rather to expand narrow-minded views of mental health issues and diverse life experiences.
Real life isn’t perfect prose. Real life isn’t a perfect plot. Real life isn’t a perfect, happy ending. Real life can be brutal, scattered, mistake-filled, and beautiful. And when these real-life teens embrace their worth and learn to use their voice, they are fierce. They are feminist AF. Like my teen patients. Like Rani.
This School Library Journal blog post lists amazing, diverse feminist YA books. I’m delighted that RANI PATEL IN FULL EFFECT is on it!
Click on this link:
Check out this awesome list of 50 young adult books, one for each of the 50 states! RANI PATEL IN FULL EFFECT IS REPPIN’ HAWAII! Yeah!
THIS IS FOR THE TEENS ON THE FRINGES OF SOCIETY I'M HONORED TO TREAT...
The characters of Jaya & Rasa are amalgams of some diverse LGBTQ teens I’ve treated, ones facing horrific situations (sex trafficked, physically/emotionally/sexually abused, bullied, and/or suffering from untreated mental health issues including suicidal thoughts and attempts). I’m grateful my version of their struggles and triumphs has been included on the 2019 In the Margins Recommended Fiction Book List!