When I was in college, I became acutely aware of the various factors that had shaped the way I related to the world and, specifically, to my mother. My mother had fashioned much of my understanding of gender. A survivor herself, she had also conquered many gender barriers that were typical of the times. She overcame gender bias and gender-based violence at every stage of her development. She told me many stories about how, since she was female, no one expected her to amount to much professionally. Naturally, she also received fewer financial and social resources than her brothers. Despite all this, she defied the odds (and her family’s expectations) by earning a PhD in Biochemical Engineering, a JD, and one or two (I lose count) MA degrees. It’s not surprising, then, that the obstacles she faced and overcame influenced the way she related to the world and, for better or worse, to me.
Even before learning about primary prevention, I had been drawn to working with survivors of sexual violence. I always looked for creative ways to increase education on this sensitive topic. It was an exciting revelation when, halfway through college, a professor spoke to us about prevention and explained a basic framework for understanding the different types: primary, secondary and tertiary. Before then, I had asked myself: “How did I/ we get here?” And, “What can we do about it now that the damage is done?” Now, I had a new question: “What can we do before the damage is done?”
Here’s my version of our professor’s explanation:
Once upon a time, there was a town that began to notice a lot of cats were falling into and drowning in the local river. This greatly upset the townspeople because they loved cats as much as I do (which is a lot). At first they went downstream and tried to save the cats (providing mouth-to-mouth and CPR), but this was SUPER tiring and not very successful. It was also not very supportive of those rescuers who really cared about the cats but were allergic to them. (As you can imagine, putting their faces next to the cats’ during mouth-to-mouth resuscitation caused terrible allergic reactions.) Ultimately, these methods only reduced the long-term impact of water exposure on the surviving cats. They didn’t solve the original problem. This type of intervention, our professor told us, is tertiary prevention.
So one brilliant townsperson thought, “Let’s move upstream.” Once the townspeople relocated further up river, they were able to rescue many more cats before they went off to cat heaven. But, even though more cats survived, many were severely traumatized. This, we learned, is secondary prevention.
Secondary prevention was a big improvement, but it, too, was SUPER tiring and still bad for those with allergies. So the townspeople decided to move even further upstream. It was only then that they came upon the source of the problem: A bunch of dogs who thought that attacking felines was a great way to prove their “dog-sculinity”, were pushing the cats into the river. (Get it? Masculinity…dog-sculinity. I know, I’m hilarious.) From this new vantage point on the river, the townspeople were able to intervene before the dogs threw the cats in the water. They began to teach the dogs that “dog-suclinity” is complex and not defined by taking away a cat’s power. The townspeople increasingly learned to make their methods proactive and sustainable. This, we learned, is primary prevention.
The focus was now on the dogs, not the cats, so the people with cat allergies were greatly relieved, and those with dog allergies were happy to find out that primary prevention requires very little physical contact.
To continue the metaphor, we who work in the field of sexual violence see our community “moving up river.” We have added proactive primary prevention to the more traditional and reactionary approaches (secondary and tertiary prevention), which can mediate the impact of sexual violence, but not prevent it. Such primary prevention programming starts early. We talk with children and adolescents about gender and how it should not be defined by denying another person’s authenticity, value or power. We teach them the meaning of consent in both everyday life and within intimate relationships.
Now, beyond the fun I had writing the above passage, this lesson has also given me new ways to think about my work. I now have more flexibility as a provider. I can still effectively reduce the impact of sexual violence using secondary prevention, but as a primary preventionist, I can also reduce the number of survivors who ever encounter it.
Even more, writing this has altered the way I think about my own history and my mother’s trauma. It has made me realize that, given a different set of circumstances, primary prevention could have changed the way my mother related to her world. It could have changed the way she shaped my relationships to the world, my partners, intimate relationships, and my self.
Then it dawned on me, “Wait, does this mean all of it could have been avoided?”
In my primary prevention fantasy, my mother would not say to my teenage self, “The only way to ensure that a man will continue to love you is if you don’t have sex with him.” Instead, she would tell me that sex with a partner is not about control, but about intimacy. She would have been horrified by my own victimization, not accepting of it as an inevitable part of my being a woman. And perhaps she would be happier, closer to me, and less mentally ill.
For me, primary prevention makes such things possible. It shows me that damage can be prevented at the source, not just mitigated after the fact. It means that a world with decreasing rates of sexual violence is a possibility, not a fantasy. Now, as our community creates interventions and strategies, we ask, “Where on the river is the best place to intervene?” And, “When we get to those places, how should we do it?”
Primary prevention has recharged my passion for working as a provider and encouraged me to reconnect with my mother. It has made me believe that violence is preventable and relationships repairable.
– A Primary Preventionist and Daughter