Editor's Comments on 'The Illness Script of Sexual Assault'

 , August 01, 2018

In one of my earliest encounters with a standardized patient, the actor grabbed her shirt and yelled, “It feels like an elephant is sitting on my chest!” She continued to volunteer an obvious list of symptoms of a heart attack, watching for my follow-up questions and proposed treatments. The encounter was as artificial as my clinical acumen was superficial at this early stage in my training. As I gained more clinical experience it became all-too-clear how frequently a clinical encounter, happening in the messy real-world, differed from the archetypal depictions I remembered in my textbooks.

In “Illness Script,” Jack Penner recounts a particularly poignant example when there might not exist a useful illness script. He recounts the story of Allie, a young artist, who was the victim of rape and seeking therapy after trying to deal with trauma on her own for months. The piece is filled with lucid and sharp descriptions that not only bear witness to Allie’s story but also give thoughtful reflection on how our healthcare system has failed her.Most incisively, when discussing personal and emotional trauma, the piece notes, “when we try to collect emotional experiences across the arc of a life and average them into one, generalizable trajectory, we serve an average that catches the reality of only a few people, if any.”

Decades ago, the physician and poet William Carlos Williams wrote in his autobiography, “My business, aside from the mere physical diagnosis, is to make a different sort of diagnosis concerning–patients–as individuals.” This task, to make a diagnosis concerning patients as individuals, is as vitally important now as it was when William Carlos Williams was writing. “Illness Script” gives us a cautionary tale of the potential consequences for our patients if our healthcare system forgets this.

Stephen Raithel