ORIGINAL

‘ ‘ i ne
HON / ‘\ i "

ADDRESS

By
C, Everett Koop, M.D,
SURGEON GENERAL
U.S, PuspLic HEALTH SERVICE
AND
DEPUTY ASSISTANT SECRETARY FOR HEALTH
U.S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

Se

PRESENTED TO THE CHILD SEXUAL ABUSE TRAINING CONFERENCE
CHICAGO, ILLINOIS
SEPTEMBER 9, 1986
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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

17M DELIGHTED TO BE HERE FOR THIS IMPORTANT CONFERENCE AND
TRAINING SESSION, IT WAS NOT THAT LONG AGO -- TWO YEARS. MAYBE
THREE -- WHEN SOME OF US IN PUBLIC HEALTH HOPED THAT JUST SUCH A

TRAINING SESSION AS THIS WOULD BE HELD.

BUT IT WAS THEN JUST A HOPE.

TODAY IT IS A REALITY HERE IN CHICAGO AND -- IN A COUPLE OF
MONTHS -- IT WILL ALSO BE A REALITY IN TEXAS AND IN THE PACIFIC
NORTHWEST AND ELSEWHERE AROUND THE COUNTRY.
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INTERDISCIPLINARY TRAINING SESSIONS LIKE THIS ONE ARE BEING
PLANNED AND CARRIED OUT, THANKS TO THE EFFORTS OF MANY DEDICATED
PROFESSIONALS, SUCH AS YOUR HOSTS TODAY, DRS. HOWARD LEVY AND JON
CONTE,

WHILE THIS MEETING HAS MANY GENERAL ANTECEDENTS, THE SPECIFIC
ONE WAS THE “SURGEON GENERAL‘S WORKSHOP ON VIOLENCE AND PUBLIC
HEALTH,” HELD LAST FALL AT LEESBURG, VIRGINIA.

ONE RECOMMENDATION THAT CAME THROUGH LOUD AND CLEAR -- AND
OFTEN -- FROM THAT WORKSHOP WAS A PLEA FOR MORE TRAINING OF HEALTH
PROFESSIONALS SO THAT THEY MIGHT PROVIDE BETTER SERVICES TO THE
VICTIMS OF VIOLENCE AS WELL AS HELP REDUCE THE LEVEL OF
INTERPERSONAL AND DOMESTIC VIOLENCE IN OUR SOCIETY.
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THE UNHAPPY FACT IS THAT MOST PEOPLE IN MEDICINE AND PUBLIC
HEALTH. IN THE COURSE OF THEIR PROFESSIONAL TRAINING, GET LITTLE OR
NO EXPOSURE TO THE MEDICAL SIDE OF VIOLENCE AND VICTIMIZATION,

THE SIGNS OF ABUSE ON CHILDREN AND ADULTS ARE USUALLY REVIEWED
ALONG WITH ALL THE OTHER INFORMATION ON PHYSICAL TRAUMA. YET THE
MARKS OF ABUSE TELL A FAR MORE COMPLEX HEALTH STORY THAN ONE OF
SIMPLE ASSAULT, AS YOU WELL KNOW:

THE ABUSED CHILD OR THE BATTERED WIFE IS BEING HURT
PRECISELY BECAUSE HE OR SHE IS A CHILD
AND PRECISELY BECAUSE SHE IS A WIFE.
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THE PHYSICAL TRAUMA IS INSEPARABLY LINKED TO THE PSYCHOLOGICAL
AND EMOTIONAL TRAUMAS. AND THOSE HEAL MUCH MORE SLOWLY. IF THEY
HEAL AT ALL.

THE ABUSER... THE BATTERER... TRIES TO STEAL FROM THE VICTIM WHAT
IS THE ESSENCE OF THE VICTIM’S BEING: SOME SMALL REMAINING KERNEL OF
HUMANITY...OF HUMAN DIGNITY...AND OF PERSONAL INTEGRITY. THAT’S THE
ULTIMATE OBJECT OF THE ABUSER.

CLEARLY OUR TASK IS NOT AN EASY ONE. BUT THE POSSIBILITIES OF
SUCCESS ARE MUCH BETTER TODAY THAN THEY EVER WERE, AND 1 SAY THAT
FOR SEVERAL REASONS:
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FIRST OF ALL. THE ISSUE OF VIOLENCE NOW HAS OUR ATTENTION, THE
ATTENTION OF THE ENTIRE MEDICAL AND PUBLIC HEALTH COMMUNITY. IT
1S HAPPENING IN MANY WAYS,..ON A PERSONAL BASIS, WHEN PHYSICIANS
AND NURSES AND OTHERS MEET IN THE COURSE OF A DAY OR AT A
PROFESSIONAL MEETING, BUT IT’S ALSO HAPPENING ON WHAT YOU MIGHT
CALL AN INSTITUTIONAL BASIS TOO,

FOR EXAMPLE, AT THE END OF THIS MONTH, AT THE ANNUAL MEETING OF
THE AMERICAN PUBLIC HEALTH ASSOCIATION, THE MEMBERSHIP WILL BE
REVIEWING A POSITION PAPER “DESIGNED TO BUILD SUPPORT...FOR THE
RECOMMENDATIONS OF THE SURGEON GENERAL’S WORKSHOP ON VIOLENCE
AND PUBLIC HEALTH.” THE PAPER, BY THE WAY, WAS WRITTEN BY AN
ALUMNA OF THE LEESBURG WORKSHOP, DR. ROSEMARY BARBER-MADDEN OF
COLUMBIA UNIVERSITY,

 
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SO, YES, THE ISSUE HAS DEFINITELY CAUGHT OUR ATTENTION,

SECOND, AN INCREASING NUMBER OF HEALTH PROFESSIONALS ARE RE-
SPONDING WITH HEIGHTENED INTEREST IN THIS ISSUE, THEY WANT TO
KNOW MORE ABOUT IT AND ABOUT THEIR ROLE IN MEETING THE CHALLENGE
OF VIOLENCE. AND CERTAINLY THE ATTENDANCE AT THIS CHICAGO
MEETING IS AN EXCELLENT ILLUSTRATION OF THAT.

IN MARCH OF ‘87 THERE WILL BE A “SECOND NATIONAL NURSING
CONFERENCE ON VIOLENCE AGAINST WOMEN.” AND WE HOPE 10 BE
PARTICIPATING IN ADDITIONAL TRAINING AND EDUCATION SESSIONS FOR
PHYSICIANS AND ALLIED HEALTH PROFESSIONALS,
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AND THIRD, WE’RE NOT ALONE IN THIS. WE HAVE NEW AND STRONG
ALLIES AMONG THE JUSTICE COMMUNITY AND AMONG THE SOCIAL WORK
PROFESSION.

IN FACT, PEOPLE FROM MY STAFF AND OTHERS FROM THE STAFF OF
ASSISTANT ATTORNEY GENERAL LOIS HERRINGTON ARE EVEN NOW IN THE
PROCESS OF PUTTING TOGETHER A NATIONAL “LAW/HEALTH INITIATIVE ON
DOMESTIC VIOLENCE.” THE PURPOSE OF THIS INITIATIVE IS TO COM-
BINE THE EFFORTS AND FUNDING OF SOME OF THE VIOLENCE-RELATED
PROGRAMS OF THE JUSTICE DEPARTMENT AND OF THE PUBLIC HEALTH
SERVICE.
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AS YOU KNOW, IT’S ALWAYS BETTER TO PREACH BY EXAMPLE, AND THIS
INITIATIVE IS AN EXAMPLE OF OUR PREACHMENT FOR MORE COLLABORA-
TION AND COOPERATION BETWEEN HEALTH AND JUSTICE PROFESSIONALS

DEALING WITH DOMSTIC VIOLENCE AT THE LOCAL LEVEL.

ONE OF THE FIRST PROJECTS UNDER THIS INITIATIVE. BY THE WAY,
WILL FOCUS ON CHILD SEXUAL ABUSE AND WILL INVOLVE PEDIATRICIANS,
SOCIAL SERVICES PERSONNEL, AND A NUMBER OF LOCAL AND STATE
DISTRICT ATTORNEYS. BUT EVEN BEFORE WE REALLY GET UNDERWAY ON
THIS INITIATIVE. MRS, HERRINGTON AND I ARE WORKING TOGETHER AND
"SHOWING OUR FLAGS,” SO TO SPEAK, AT EVENTS SUCH AS THIS
TRAINING SESSION. WHICH IS A GOOD EXAMPLE OF WHAT OUGHT TO BE
OCCURRING RATHER ROUTINELY. ONCE THE IDEA BEHIND THE INITIATIVE
IS WELL AND WIDELY UNDERSTOOD.
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] HOPE YOU CAN TELL THAT I’M VERY EXCITED ABOUT THE LONG-TERM
POTENTIAL OF THIS “LAW/HEALTH INITIATIVE.” WE’LL BE SAYING MORE
ABOUT IT LATER THIS FALL.

THINGS ARE STARTING TO HAPPEN, BUT BEFORE WE GET CARRIED AWAY,
LET'S REMEMBER THAT THE KEY WORD IN THAT OBSERVATION IS THE WORD
"START."

ALL THE ACTIVITIES I’VE MENTIONED -- AND THEY ARE ONLY A
FRACTION OF WHAT IS GOING ON -- REALLY REPRESENT JUST THE BEGINNING
OF OUR NATIONAL EFFORT TO DEAL WITH VIOLENCE -- ESPECIALLY DOMESTIC
VIOLENCE -- AS A PUBLIC HEALTH ISSUE. IT’S A START.
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BUT I WOULD URGE YOU NOT TO FOCUS SO COMPLETELY ON THE PROBLEM
OF CHILD ABUSE AND CHILD SEXUAL ABUSE THAT YOU MISS THE REST OF THE
CONSTELLATION OF PAIN AND BRUTALITY THAT IS FAMILY VIOLENCE. THESE
TERRIBLE EVENTS TEND NOT TO OCCUR IN ISOLATION. FOR EXAMPLE...

IN A HOME WHERE A CHILD IS BEATEN, THE MOTHER MAY BE ASSAULTED.

WHERE AN INFANT IS BEING ABUSED, SOMEONE MAY ALSO BE TERRORIZING
ITS GRANDPARENT,

AND WHERE A DAUGHTER IS SEXUALLY ABUSED, HER MOTHER MAY BE
RAPED,
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WE DON’T LIKE TO THINK ABOUT THESE THINGS, YET THEY ARE PART OF
THE DARK AND BRUTAL WORLD OF FAMILY VIOLENCE...A WORLD WE NOW KNOW
WE MUST ENTER IN ORDER TO EFFECTIVELY TREAT ITS VICTIMS AND SAVE
THEIR LIVES,

A PEDIATRICIAN TAKING CARE OF A SEXUALLY ABUSED CHILD HAS
ENOUGH TO DO WITHOUT TAKING ON THE REST OF THE FAMILY, 100. THAT
STATEMENT CERTAINLY HAS THE RING OF TRUTH TO IT.

BUT NOT QUITE THE WHOLE TRUTH. THE CHANCES ARE PRETTY GOOD
THAT SOMEONE... SOMEWHERE ELSE IN MEDICINE OR PUBLIC HEALTH...IS
GOING TO BE CONFRONTED BY THE ADULTS OF THAT FAMILY, ALSO..AND WILL
SOMEHOW HAVE TO TREAT THE PHYSICAL TRAUMA AND MENTAL DISORDER THAT
MARK THE LIFE OF SUCH A FAMILY.
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IN OTHER WORDS, THE QUESTION SEEMS TO BE THIS: HOW CAN YOU DO
YOUR JOB FOR YOUR PARTICULAR PATIENTS -- CHILDREN IN DIRE NEED OF
YOUR SERVICES -- WITHOUT COMPARTMENTALIZING THE PROBLEM ANY FURTHER?

1 DON’T KNOW THE ANSWER TO THAT ONE. I WISH I DID. BUT I
DON'T,

BUT WHAT I DO KNOW IS THAT IT’S A QUESTION THAT IS BECOMING
MORE PROMINENT AS MEDICAL AND PUBLIC HEALTH PEOPLE GET MORE INVOLVED
IN TREATING VICTIMS AND IN HELPING REDUCE THE LEVEL OF VIOLENCE
GENERALLY.
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NOW, LET ME CLOSE WITH A FINAL WORD OF THANKS TO THE SPONSORS
AND ORGANIZERS OF THIS MEETING. AND A SPECIAL WORD OF THANKS TO
THOSE WHO TOOK THE TIME OUT OF THEIR SCHEDULES AND AWAY FROM THEIR
PROFESSIONAL PRACTICES TO COME HERE TODAY.

I BELIEVE IN THE MONTHS AHEAD YOU WILL RECALL THIS AS HAVING
BEEN AN IMPORTANT DAY FOR YOU AND CERTAINLY FOR THE CHILDREN OF THIS
AREA,

THANK YOU,

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