This is an interesting article posted at AlterNet, but originally from Psychotherapy Networker, on the nature of childhood sexual abuse and its aftermath. It is excerpted from The Trauma Myth: The Truth About the Sexual Abuse of Children and Its Aftermath by Susan A. Clancy (2009).
I have some issues with the perspectives offered here. Let's start with this passage from early in the article:
How can trauma be the cause of harm if most victims say that the abuse was not traumatic when it happened? A growing number of scholars in the sexual abuse field are coming to agree that understanding how and why sexual abuse damages victims probably has little to do with the actual abuse and a lot to do with what happens in its aftermath.This all depends on the severity of the abuse. Some abuse is physically painful and frightening and there is no doubt that this leaves serious psychological scars. However, and this is a big however, the damage that results is mitigated by the temperament of the child. Some kids are more resilient and while they will experience psychological issues later in life, others will end up with serious dissociative disorders, all the way up to dissociative identity disorder.
Non-violent forms of abuse, where the perpetrator is more seductive, still damages the developing psyche of the child. If we consider attachment theory and subpersonality theory (especially the Internal Family Systems model), it's clear that the young child may have no clear sense of the situation and may even experience the abuse as affection, but that does not alter the fact that the child's psyche is being damaged.
One outcome is the sexualization of affection that may manifest in young women (or men - one in five victims is male) as seeking physical sexuality as a sign that they are loved by their partner. Another outcome, based in dissociative theory, is that there will be "exiled" parts (or disowned parts) of the self that may hold the memory of the event(s) and keep them out of consciousness. The following is a brief but useful explanation of how childhood trauma, such as sexual abuse, can impact the psyche:
What the author of this new book may be seeing is that, like many experiences, sexual abuse impact falls along a spectrum. There are many factors that can influence how the child will handle the experience. But she is correct that we need to shift the focus of the trauma to how it is experienced today, right now, in the ways the victim attempts to make sense of it in their lives.Symptoms of dissociation resulting from trauma may include depersonalization, psychological numbing, disengagement, or amnesia regarding the events of the abuse. It has been hypothesized that dissociation may provide a temporarily effective defense mechanism in cases of severe trauma; however, in the long term, dissociation is associated with decreased psychological functioning and adjustment.[24] Other symptoms sometimes found along with dissociation in victims of traumatic abuse (often referred to as "sequelae to abuse") include anxiety, PTSD, low self-esteem, somatization, depression, chronic pain, interpersonal dysfunction, substance abuse, self-mutilation and suicidal ideation or actions.[23][24][28] These symptoms may lead the victim to erroneously present the symptoms as the source of the problem.[23]
Child abuse, especially chronic abuse starting at early ages, has been related to high levels of dissociative symptoms in a clinical sample,[29] including amnesia for abuse memories.[30] A non-clinical sample of adult women linked increased levels of dissociation to sexual abuse by a significantly older person prior to age 15,[31] and dissociation has also been correlated with a history of childhood physical as well as sexual abuse.[32] When sexual abuse is examined, the levels of dissociation were found to increase along with the severity of the abuse.[33] The level of dissociation has been found to be related to abuse.[33]
The fact remains, as she acknowledges, that as adults many of these victims have a difficult time in many areas of their lives as a result of the abuse. The fact that they did not reject the contact in many cases, or even might have enjoyed it, creates an incredible amount of self-blame and shame. If nothing else comes of this book, it will be crucial that adults understand that as children they handled the abuse in the only ways a child mind could - and that does not make them bad people at all responsible for the abuse they suffered.
June 4, 2010
From the book The Trauma Myth: The Truth About the Sexual Abuse of Children and Its Aftermath by Susan A. Clancy. Copyright © 2009 by Susan A. Clancy. Reprinted by permission of Basic Books, a member of the Perseus Book Group.
Tell us what you think about this article by e-mail at letters@psychnetworker.org, or at www.psychotherapynetworker.org. Log in and you'll find the comment section on every page of the online Magazine section.As a graduate student at Harvard in the mid-1990s, I participated in research studies carried out by the psychology department that began in October 1996 and continued until August 2005 to interview adults who had experience sexual abuse as children and learn what effects the abuse had had on their lives. Although I was sure I knew what I would discover—that the abuse would be remembered as a horrible experience that overwhelmed the people I interviewed with fear when it happened and had always been viewed as a traumatizing occurrence—what I heard in the hundreds of interviews I conducted was quite different. In nearly all the cases, the adults I questioned had not experienced the abuse as traumatic when it occurred and only came to regard it as so years later. And in many of the cases, they had never been questioned about their evolving sense of the abuse and the ongoing impact that it had on their lives, but only about what the traumatic experience had been like at the time. These findings led me to question the progress professionals in the sexual abuse field have made when it comes to understanding and treating child sexual abuse.
Certainly we have advanced to the point that the right things are being said (sexual abuse is common and harmful; it is never the child's fault). Funding in the trauma field has been secured, research conducted, studies and books published, treatment centers established, and public awareness raised through sex-education programs and campaigns in the media. But is any of it translating into actual progress for victims? Do they feel that they're being helped, that they're understood and their needs are being served effectively?
The trauma model's main purpose—one of the primary reasons why mental health professionals welcomed it with such enthusiasm in the 1980s—was to provide an explanation for how and why sexual abuse wreaks such psychological and social havoc in victims. Armed with a better understanding of the impact of abuse, mental health professionals hoped to be better able to help victims cope with and recover from these damaging crimes.
The problem is that today, after more than twenty-five years, predictions based on the trauma model have not proved accurate. Characteristics of the sexual abuse experience related to trauma (like how frightening it was, whether penetration or force was involved, and how many times it happened) do not do a good job of forecasting the level of long-term psychological harm experienced. There appears to be no direct, linear relationship between the severity of the abuse and the psychosocial difficulties victims experience in adulthood. Worst of all, we have developed no clearly effective treatments for sexual abuse victims. They continue to suffer from psychological and social problems in the aftermath of their abuse, and mental health professionals still have not reached a consensus as to exactly why or what precisely to do to help them recover.
This state of affairs is far from surprising. How can trauma be the cause of harm if most victims say that the abuse was not traumatic when it happened? A growing number of scholars in the sexual abuse field are coming to agree that understanding how and why sexual abuse damages victims probably has little to do with the actual abuse and a lot to do with what happens in its aftermath. For example, as David Finkelhor concluded in his recent book Childhood Victimization, continuing research efforts that seek to track the consequences of early events through developmental, cognitive, and behavioral pathways may prove more fruitful than continuing the restrictive focus on the severity and nature of event-specific trauma. I believe that the victims themselves have always known this.--------------
Jen was a sixty-five-year-old, divorced, retired administrative assistant. A tall, big-boned redhead with long purple fingernails, she was up front about lots of things. She did not like the coffee I gave her, my office was too cold, and she did not like the color of my hair. We were at the part of the interview when I asked her to rate how traumatic her abuse had been when it occurred. She did not like the questions I asked.
"Nothing personal," she said, "but these questions are kind of dumb. If you are trying to do what you say you're trying to do, and figure out why the abuse screwed me up so badly, why are you asking so many questions about what it was like when it happened? What you need to be focusing on was what it was like later on."
I asked what she meant. "What I mean is that what it was like when it happened and what it is like now are two separate things entirely."
At that point in my career, I did not have a lot of experience interviewing sexual abuse victims. I had, however, a lot of experience interviewing victims of other kinds of horrible experiences (motor vehicle accidents, combat, natural disasters, abductions), and I had asked these subjects to rate how traumatic the events were at the time. No one in these studies had ever said this to me before. And as far as I knew at the time, scholars were not talking how perceptions of the traumatic nature of an abuse experience change over time—how an event not initially perceived as horrible could become so. They certainly talked about how symptoms of trauma (depression, anxiety) might not manifest themselves until long after the abuse, but they were not talking about how perceptions of the abuse itself can change.
I knew I had to consider Jen's words seriously. From that point on, I asked my question in two parts: What was the experience like when it happened? And what is the experience like for you today, looking back on it.
By the end of the study, the data was clear. Although sexual abuse was not a particularly awful experience for many victims when it happened, looking back on it, from their perspective as adults, it was awful—ratings of shock, horror, disgust, and even fear were all high. Obviously, perceptions of abuse when it occurs and when victims look back on it years later are entirely different. In addition, sexual abuse is very different from other kinds of terrible life experiences. For example, getting into a car accident is traumatic both at the time it happens and later when it is recalled. Sexual abuse, however, becomes traumatic later on. Why? What happens in the aftermath of sexual abuse?
According to victims, they did not experience the abuse as awful when it happened because most simply did not understand clearly the meaning or significance of the sexual behaviors they were engaging in. That being said, at some point later on in life, they do. Over time, the "cloak of innocence lifted," as one victim described it. Victims reconceptualized the formerly "confusing and weird experiences" and understood them for what they were—sexual in nature and clearly wrong. Only at this point—when the sexual abuse is fully apprehended—does it begin to damage victims.
Reconceptualization
When Anne, a twenty-eight-year-old mother of two, was eight years old, her mother started working outside the home. Between 3 P.M. when Anne got home from school and 6 P.M. when her mom came home from work, a neighbor and friend of her mother's named Frank would babysit. Frank sexually abused Anne. Sometimes, when Anne was sitting in his lap, he would "put his fingers inside my panties and feel me up . . . and while this was going on he would thrust himself up against my butt and he would be breathing heavy."
When it was happening, Anne said she did not like what he was doing but was "definitely not traumatized." And she was not different from most of the victims who spoke to me. "I knew it was something I shouldn't talk about with my mother, but not really exactly totally sure why." After about eight months of intermittent abuse, Frank left town, and Anne said she "just didn't think much about it again." But then something changed.
Anne reconceptualized her abuse—she figured out the meaning of these previously ambiguous experiences. "I remember this like it was yesterday. . . . I was in eighth grade and my friend Jennie was over and she had seen her brother and his girlfriend making out and she was reenacting them rolling around on the ground and moaning and it was then [that] I remembered what happened; it reminded me of what happened. . . . I realized, totally all of a sudden, that what had happened to me was sexual—that I had basically been having sexual experiences with my babysitter when I was kid." It took Anne six years to cognitively reconceptualize what happened to her and understand that it was wrong.
Betrayal
When they discover that they have been abused, victims most frequently report feelings of betrayal. As Cheryl, a forty-three-year-old high school teacher on maternity leave with triplets, put it, "I realized that I trusted him, what he was doing, and I should not have. He knew he was doing something wrong, and he knew I didn't know. . . . It was all an elaborate game of sexual betrayal." As Neil, an AIDS activist working for a hospital in Boston, said, "I realized that it wasn't just what he did to me physically. At that moment [of discovery] I lost my father. He was no longer someone who loved and took care of me. I was just being used by him for his personal gratification."
For the victims who spoke to me, the degree of the betrayal was a function of two main variables. First, it depended on how close the victim felt to the perpetrator, on how much he or she trusted, cared about, or loved him. The second variable was the degree to which the victim believed he or she had been emotionally manipulated by the perpetrator or "taken in" by the situation. In those cases in which the abuse was traumatic when it happened (it involved force, violence, or pain), victims subsequently felt less betrayal. Since in these cases the children clearly understood the wrongness of the situation, any sense of betrayal arose immediately. And, because the children understood they were being victimized, the abuse was unlikely to happen again (or if it did, the child remained well aware of his or her victimization). Thus, victims did not have to undergo long periods in which they unknowingly fell prey to, as one subject told me, the perpetrator's "elaborate games of sexual betrayal." As Tom, a neurosurgeon, put it, "For two years, while it was happening I felt good about him. I believed him, all his lies and let him do whatever he wanted. It makes me sick to think about how much I trusted him, how much, for how long he took advantage of that." In other words, the degree of betrayal victims felt in the aftermath was an inverse function of how traumatic the abuse was when it happened: the less traumatic it was, the more betrayal victims reported.
As a consequence, many told me, this betrayal forced them to rethink the past. For many victims, a former sense of security is shattered; many report feeling a new sense of interpersonal insecurity and vulnerability. As Maria told me, "The day I understood what happened to me, I completely lost my own sense of security. The childhood I imagined I had—the safety that enveloped me—was shattered. The people who were supposed to be looking out for my well-being [and] taking care of me were not."
Betrayal affects not only victims' feelings of security and trust in others but also their self-worth. They feel that since they must not have been loved, perhaps they were not worth loving. As Charles, a history professor, explained to me, "You learn that who you are and what you might want or need just does not matter."
Considering the degree and extent of the betrayal victims felt, I expected anger at the perpetrator to be a common reaction. Yet only 5 percent spontaneously reported feeling angry at their abuser. Why would the victim of a crime punishable in almost any court system in the world not be angry at the perpetrator? According to victims, it is because they turned the anger inward. Most, to a shocking extent, blamed themselves.
Self-Blame
According to philosophers, psychiatrists, and intellectuals from Aristotle to William James, from Sigmund Freud to Donald Spence, when bad things happen to people—like discovering they were sexually abused by an adult they trusted—it is human nature to want to engage in a search for meaning, to understand why the event occurred and what its implications for one's life are.
As victims struggle to make sense of their experiences, they engage in an attribution process: they scan through all the possible explanations they can generate to come up with the one that they believe fits best. Traditionally defined, attributions are individual causal explanations for why events occur.
If a victim asks, why did someone I trusted abuse me? there are, of course, endless possible answers. For example, he was screwed up or drunk, or I was in the wrong place at the wrong time. The famous attributional theorist, Martin Seligman, would refer to this category of answers as "external explanations for negative events." It assigns responsibility for the event to someone or something else. But almost all the victims I've spoken with, to some degree, endorse an "internal" explanation. They see the abuse as their fault—caused by their own characteristics or behavior.
I asked victims who was to blame for the abuse—them, the perpetrator, or both. Almost 80 percent felt both were at fault. While almost all could acknowledge that the perpetrator was responsible, they also thought they had done something wrong too.
Again, I have found that the degree of guilt victims feel in the aftermath of sexual abuse is strongly related to the degree of trauma experienced during the abuse when it happened. Specifically, the less traumatic (forceful, frightening, threatening) the abuse was while it occurred, the more guilt and self-blame the victims report later on. Those victims whose abuse involved force or violence usually report the least guilt. In such cases, the victims know it was not their fault. One of the victims I spoke with summarized this quite well: "I was bleeding. I screamed when it was happening. He ran away. I got rushed to the hospital. It was pretty clear to me that he had done something wrong, that it was definitely not my fault." Victims who report no trauma at all during the abuse (for example, those who loved the perpetrator, enjoyed the attention, or occasionally welcomed the contact) feel extremely guilty.
Today, most adult victims' knowledge about sexual abuse, about what it is like when it happens and how children react at the time, is a function of what they hear, read, and see in the media—the culturally available, standard scripts about this crime. Because of the trauma myth, according to these scripts, sexual abuse usually involves fear, force, and threat. The experience is portrayed as terrible for the victims. They are frightened when it happens. They try to resist the abuse. Whatever happens clearly happens against their will. Books, films, and websites repeatedly assure victims that they had no control, that they were utterly helpless. Words like "rape," "assault," and "violation" are commonly used to conceptualize the experience.
No professionals explicitly discuss with victims or highlight the real dynamics of sexual abuse—that victims rarely resist it, often care about the perpetrators, and often receive "benefits" for participation, like praise, attention, and gifts. In fact, this kind of information may actually be suppressed. It appears to be an article of faith among professionals that you should not talk about aspects of sexual abuse that run counter to the trauma model at all. A wildly popular book written for professionals by Judith Herman warns professionals not to talk about the issue of consent as doing so will likely make the victims "feel revictimaized again."
Because of the trauma myth, I am aware of no public information campaigns that say, "Kids don't know enough to say no." There are no books telling victims, "You let it happen, and it's okay. It's normal. You were too good to know bad." I know of no newspaper stories in which the victim comes forth after years to press charges and explicitly says, "I would have done it earlier, but I just didn't understand I was abused until now." Today, as a function of the mental health field's relentless emphasis on trauma, force, and violence and the subsequent embargo on any real-world, practical information about the reality of sexual abuse, most victims' experiences slip under the radar—their stories are ignored, dismissed, overlooked, or denied by the very people who purport to be trying to help them.
What is the consequence? For victims, it is significant. They naturally compare what happened to them with the depictions of abuse in cultural scripts. As James, a nurse, told me, "What happened to me was different from other kids. I . . . well . . . it's hard to say out loud, but basically I let it happen." There is something wrong with me. As Denise, a bathing-suit model, noted, "I wasn't afraid. Sometimes I liked it. Obviously something's screwed up with me." I am alone. Claudia explained, "My abuse did not involve such force and violence. I basically let it happen . . . so it wasn't classical abuse."
Given the degree of betrayal, guilt, and isolation victims feel, it is not surprising that they also commonly report shame.
Shame
Shame is an awful emotion, one in which the self is viewed as incompetent and as an object of ridicule, contempt, and disgust. Individuals feeling shame often view themselves as damaged and unworthy. Unfortunately, most victims use the word "shame" to describe how their abuse makes them feel as adults. As one victim summed it up, "I think the heart of the damage is shame. It eats away at me. It has eroded my sense of self-esteem and my confidence, my ability to love and feel loved. The abuse stopped when I was twelve; the shame remained my whole life."
Further support for the perspective that what damages most victims has little to do with any trauma they experience during the abuse and a lot to do with the shame, guilt, and isolation they feel later on in life comes from the fact that in the handful of studies that have specifically tested it, therapeutic techniques involving cognitive retraining—identifying victims' irrational beliefs (for example, that the abuse was their fault) and then helping them to modify these beliefs (for example, by providing convincing information about why it was not their fault)—have shown solid promise in improving the lives of victims in the aftermath of sexual abuse.
Today, victims need to hear the truth. This requires us all to highlight publicly the true dynamics of sexual abuse—to expose the painful reality that most victims care for and trust the perpetrator (before, and sometimes during and after, they are abused), that they do not really understand the nature of what is being asked of them, that they feel they are receiving love and attention, that it does not hurt and sometimes feels good, and that, for all these reasons, participation is common.
Once exposed to the truth about how victims feel and behave during sexual abuse, victims need to hear, loudly and clearly, why they were not at fault. We cannot accomplish this with platitudes or blanket statements like "You were not to blame" or "It was done against your will." They consented not because they were forced to but because they did not understand enough not to. And victims need to know that this is normal. Although they made an error of judgment—ideally they should have said no; they should have resisted—we must reassure victims that given their age and level of cognitive and physical development, this error of judgment was understandable.
In short, in order to help victims feel less stigmatized in the aftermath of sexual abuse, we must all communicate that they were helpless victims—not, as the trauma model portrays them, literally helpless but metaphorically helpless, victims of their own level of development.
This information needs to be highlighted in the form of prevention campaigns, books, websites, and other culturally accessible outlets. Until that happens, victims will continue to feel alone, guilty, and ashamed.
Professionals may fear that raising attention to children's participation in abuse will elicit in others a tendency to condemn victims, but I think we better get past this. Victims are already condemning themselves. Here is the tragic paradox. If the victim's cognitive interpretation of the event guides the process of psychological adaptation after sexual abuse, then the trauma theory is not only wrong but actually backwards. The less traumatic sexual abuse was when it happened, the more betrayal, guilt, isolation, and shame victims will feel and the more psychological distress and dysfunction they may experience in the aftermath. And because it is backwards, the trauma model is not just failing to help victims; it is actually causing some of the harm it was supposed explain by simultaneously exacerbating the victim's damaging beliefs ("It was my fault," "I am alone," "There is something wrong with me") and suppressing the information that would neutralize them.
~ Susan Clancy is the author of The Trauma Myth: The Truth About the Sexual Abuse of Children and Its Aftermath.
No comments:
Post a Comment