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A few things have happened in Pennsylvania recently that we should find encouraging. Bill Cosby was finally found guilty of sexual assault and two friars were charged for protecting a priest who they knew was molesting children. The near complete absence of legal consequences for rapists and those who stand by and do nothing about them is horrifying. That it may slowly be changing is a victory for activists. I felt a swell of hope when they announced the Cosby verdict. I belted out some Kesha on my drive home and cracked open a cider as I told my husband the news.

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But as this tide shift begins, there are certain things that must be said.

I have been seeing patients in my office for medical marijuana certification these past few months since Pennsylvania’s first dispensaries opened. It is amazing work to do. I hear so many heartbreaking stories of patients not only suffering illness but being abandoned by the medical system, struggling to hold onto hope. Their diagnoses range from cancer to pain to ALS to autism to seizures. And PTSD.

As a certifying physician, I am simply assessing if a patient has one of the 17 qualifying diagnoses Pennsylvania has designated to receive a medical marijuana card. As such, patients bring records from their treating physician and I use those records along with a history and physical exam to determine if they do indeed have the condition and are appropriate for medical cannabis therapy. They come to me because their physician either doesn’t believe in cannabis or, more often, recommends it for them but cannot certify them. A physician in Pennsylvania must go through a special process in order to be able to certify for medical marijuana and many physicians are reluctant to do so for a variety of reasons.

When I see a patient for PTSD I ask them about their symptoms, what other treatments they’ve tried, how long they’ve had PTSD and how its changed over time, and what their treatment goals are for medical marijuana. I do not ask them for the details of their trauma. It’s not medically necessary for what I am doing with them and just as I’d never perform an unnecessary pelvic or rectal exam, I am obligated as a physician to avoid being unnecessarily intrusive on a patient. If you’ve lived trauma then you know talking about it can be a more vulnerable and difficult procedure than an internal exam.

Still, patients often tell me their stories. I hope it is because they feel safe with me. I hope it helps them to speak their truth to me. It certainly helps me to hear their stories. It makes me a better physician and a better human being.

For the most part, I just listen. There are rarely words powerful enough to reflect back to them what they have just told me. I know it and they do too. Trauma is a language like no other. Sometimes I say to them, that’s horrible. I can’t imagine. I’m so sorry that happened. Sometimes I just listen and look and they know that they’re heard and that’s what matters.

I say nothing here of anyone’s story. Of any specifics. Anonymous or not. But I will tell you, dear reader, that something has surprised me. After spending all these years learning about trauma, thinking about trauma, writing about trauma, speaking to other rape trauma survivors, I have taken something new from it.

Many of my patients have gotten PTSD from being in prison. I wasn’t expecting that. And it makes me think of Jeremy. There was a time in my trauma healing process where I savored the idea of him being attacked in prison. I’m not proud of it but I do accept it as part of my journey through PTSD to the other side. It is not something I allowed myself to get stuck in. I believed before I ever met Jeremy in the importance of the corporal act of mercy of visiting the imprisoned. I recognized the inhumanity of our criminal justice system. And that wasn’t something I was going to let Jeremy take from me.

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I cannot imagine how hard it would have been to let this idea go if I hadn’t been one of the extremely rare few whose attacker actually gets prosecuted, found guilty and imprisoned. I have a safety and a sense of justice that is almost unheard of (even in the case of convicted rapists, it is rare they get the 45 year sentence that Jeremy did. I need not worry about the day he gets out and comes for me. I did not face the indignity of him getting a slap on the wrist sentence). Letting go of anger and the desire for vengeance when justice is denied seems almost impossible.

What I cannot excuse or validate is the similar sentiments expressed by those not involved in a particular perpetrator’s trauma. We have all heard and seen on the interwebs the comments of so many people when someone is found to be a rapist or child sexual predator. They make comments, some purely serious and others sickly comical, about the fact they hope the perpetrator will be raped in prison. An eye for an eye, a rape for a rape.

It perpetuates the idea that prison is a place where the “regular” prisoners will institute vigil ante justice and give these deserving sexual predators their come-uppance. Not only does it violate morality in its wishes for violent harm of the sexual perpetrators, it presents a narrative of prison where those who’ve committed so called victimless crimes are seen as being free from being targets of violence. Prison is a macho sort of wild west where unsavory elements make up for their crimes by using their lack of obligation to societal norms to take care of the dirty work of making these rapists pay appropriately. They atone for their sins and satisfy out blood lust in one fell swoop.

The reality is that prison brings trauma to every prisoner whether they’re their for drug possession, repeated DUI, writing bad checks or murdering their mother. And the reality is, most prisoners are there for something like drug possession or writing bad checks and end up being punished not with time away from their families, home and work, but with assault, both sexual and non. They live in a constant state of fear and hypervigilance. They suffer violence, witness violence and are forced at times, in order to survive, to perpetuate violence. This is something those of us who’ve experience protracted trauma can identify with. This is trauma. This is hell. And no one deserves it. Not even rapists and men who kill their mothers. And certainly not twenty year olds who made a stupid decision and got caught (I speak not here of rich white twenty year olds who make stupid decisions. They don’t go to prison). Their sentence may only be a few years but the PTSD lasts the rest of their life. It is not moral. It does not benefit society. And it deadens all of our souls as a culture for perpetuating this brutal system.

When you call joyfully for anyone to be raped, whether they themselves are a rapist or not, you are promoting rape culture. You are ensuring little girls will go on being raped. I realize it makes *you* feel better and that’s just great because it’s all about you, but you sacrifice the bodies, minds and souls of little girls and boys and women and men.

No one deserves to be raped. Period. Ever.

We do need justice for survivors in this country. I am glad that Bill Cosby and these friars and Jeremy Noyes will be held accountable and it is vital for ending rape and for providing survivors what they need to heal. Prison as we have it in this country, however, is not the answer. When will we establish a humane justice system that truly serves victims and keeps us safe as a society? Until then, rape culture will thrive.