I worked part time for my granduncle’s business when I was 13 and 14. There were many times when we were alone, and he sexually abused me. I never raised it with my parents in those early years; I doubted I would be believed, and my granduncle was a ‘‘kind old man’’ who was very generous to my financially strained family.
In my late 20s, while in therapy, I began to realize the impact those experiences had on me. I told my husband and my parents what happened all those years ago. I received the essential support I needed from my father and my husband. But my relationship with my mother became fraught. When I shared the events with her, she told me that the same man sexually abused her when she was a teenager and that she never told anyone. At first, we were angry about the impact on both of us, but then I became angry at her for not protecting me. How could she have possibly allowed her teenage daughter to regularly be alone with this man? She said that because he was an old man when I worked for him, she didn’t think he would still do the same things. She also asked that I not share this information with my father, fearing that he would blame her for not protecting me.
Knowing that the truth might destroy their marriage, I have remained silent about my mother’s experience and have kept it a secret at her request. I encouraged my mother to attend counseling to address the issue, but she has never done so. Nor has she told my dad. I’ve lost a lot of respect for her over this; her decision seems a selfish one.
I am now in my 50s, my parents are in their 80s and the secret is still buried. My dad continues to ask why I don’t spend more time with my mother; it clearly bothers him. I wonder if it is time to share the secret with him. Is unburdening myself of this secret worth causing disruption and sadness at this late stage of my dad’s life and my parents’ 60-year marriage? — Name Withheld
From the Ethicist:
I’m so sorry to hear about what you’ve endured; it clearly took courage to tell your family about what happened to you and to seek therapy to deal with its effects. Your mother’s behavior, meanwhile, can only have heightened your experience of betrayal. In sorting through the issue of disclosure, you should give serious weight to your own well- being.
On the plus side, unburdening yourself to your father will allow him to understand why you don’t spend more time with your mother. More speculatively, it might also enable an honest and open discussion with your parents. So a big question is how likely it is that disclosure will lead to greater empathy, acknowledgment and understanding within the family.
On the minus side, it could, as you say, derail your parents’ six- decade marriage; your father might resent not just your mother but also you for having kept him in the dark for so many years. Disclosure could further undermine your relationship with your mother, who might feel that you had broken an agreement you reached. Another big question, then, is how such developments would affect you.
I wish that these painful situations could be reduced to simple slogans — ‘‘you’re only as sick as your secrets’’ and the like — and that transparency invariably made things better. I do think that, as a rule, we should know the important truths about our partners. But when we’re looking at an octogenarian couple, other things matter, too. Perhaps knowing the truth could have helped your father shape his life 30 years ago; now, as he approaches his final years, it might cause him more pain than it’s worth. I also worry that whatever feelings of relief you experience after unburdening yourself would be fleeting, while your father and mother’s different forms of aggrievement might not be. You’ll have to decide, in the end, whether revealing the truth will help heal your injuries or deepen them.
Readers Respond
Last week’s question was from a doctor who was worried about one of her former patients. She wrote: “I’m a family physician. A young woman expecting her second child came to me for obstetric care. She had a black eye — not the first one, she told me. She worked as a topless dancer, but her boyfriend was so controlling and abusive that she did not have money of her own. … We developed a relationship meaningful to us both. About a year later, she told me that she was getting breast augmentation, at a cost of thousands of dollars, which she intended to pay for in cash from her earnings. Around the same time, I discovered pre- to early cancer in her reproductive tract, and treatment was imperative to prevent progression of the disease, or risk dire consequences. She was insured by Medicaid, which is paid for with tax dollars. I think she probably didn’t report her entire income to the I.R.S. or Medicaid, or she probably would not have been eligible. I told her I didn’t think I could ethically bill Medicaid for the diagnosis and management of the potential cancer while she was paying cash for breast surgery. … She never came back. I still wonder what happened to her and pray she found a new, self-respecting way of life. I wonder if I handled it as well as I could have.”
In his response, the Ethicist noted: “Your relationship with this young woman was not that of an accountant or a tax auditor but that of a health care provider. True, she chose to disclose something that gave you grounds to believe that she had been misreporting her income. But there are people whose job it is to deal with that issue (although fraudulent claims submitted by providers are a bigger problem for Medicaid than ineligible recipients are). You say you didn’t want to risk your medical license. Has anyone you know lost a medical license because a patient misrepresented her income to the state Medicaid program? Whatever your personal opinions might be about this woman’s livelihood, your job was to keep her healthy, not to keep her honest. … Given your specific duties of care, your priority wasn’t to look after the government coffers; it was to look after your vulnerable patient.” (Reread the full question and answer here.)
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I agree with the Ethicist. The doctor’s job is to provide health care and not make moral judgments about her patients. Breast augmentation for a stripper enhances her earning opportunities. If she’d saved up cash for a wedding, a car or tuition at nursing school, would the letter writer be so quick to refuse lifesaving care? — Tobi
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For someone who makes a living as a topless dancer, breast augmentation is not a frivolous cosmetic procedure — it’s an investment in her earning potential. I feel sad for both the doctor and the patient that the doctor let her moral judgment win out over the fragile relationship she was building to keep the patient healthy. It seems to me that the young woman was making what looked like the best choice for surviving (and perhaps escaping) a precarious situation. That her choice was different from what the doctor would have chosen is irrelevant. I wonder if deep down, the doctor’s moral high ground wasn’t about the money at all, but was instead shaped by sexual shame. — Anna
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I believe the Ethicist’s response was absolutely wrong. As a family doctor, I totally agree with the letter writer’s initial instinct. — Tom
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The doctor’s outsize sense of morality, which was inflicted on the patient by the refusal to bill Medicaid for potentially lifesaving treatment, strikes me as being akin to the physical and financial control the patient’s boyfriend exercised over her. I’m a taxpayer, and I say the lady should have been treated by a doctor who exhibits more respect and compassion for patients. — Sharon
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As someone who works for a state Medicaid program, I appreciate the Ethicist’s response. Unless a person determines eligibility for their state’s coverage groups and knows the policy, state law and federal rule for the state’s specific medical coverage programs — and has reviewed the applicant or beneficiary’s financial documentation — they cannot say if someone is eligible for Medicaid. Nor should they. I have been on the receiving end of Medicaid, and now I’m in the foremost position in my state to determine who should receive it. It is not my job to scrutinize the lives of those who need health care. It is only my job to see if they meet the criteria and to be kind while doing it. I would encourage this physician, and anyone assuming they are allowed to pass judgment because someone receives a state or federal benefit, to mind their side of the street. — Em
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