What can adult survivors of child sexual abuse teach psychologists?

1
What can adult survivors of child sexual abuse
teach psychologists?

• Dr Vicky Gunn
• Learning and Teaching Centre

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Introduction

• Some background research information on extent
  and long-term consequences of child sexual abuse.

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From a scan of USA research evidence

• First and foremost, exposure to unwanted sexual
  attention in childhood is not uncommon..
• ..there is consistent evidence to suggest
  that 5-10 of children are exposed to severely
  abusive acts involving actual or attempted sexual
  penetration.
• (Fergusson Mullen, 1999)

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Impact of child sexual abuse

• Depression, anxiety
• Risk-taking behaviours (self-harm aggression
  eating disorders)
• Relationship fear
• Sexual fear / sexualization
• Low self-esteem
• Fragmented self (post-traumatic stress disorder/
  dissociative disorders)

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Perspectives from practice
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Pain kept in the familygeneaologies of abuse

• Grandmother Grandfather
  Grandmother Grandfather
• (abused as child) (abuser)
  (abusive) (abuser)
• Father Mother Sibling Sibling
  Partner Sibling Sibling Sibling
• (abuser) (abused by father) (abuser) (abused
  by father)
• Child Child Child Child
  Child Child Child Child
• (abused by grandfather and (abused by
  father) (overly protected
• father) emigrate)

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The power of emotional pain

• Sometimes Ill just be walking down the road and
  suddenly Ill feel such pain, like Ive been
  sliced by a knife. Other days the pain just goes
  on in my head constantly.

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The weight of memory

• Things would be basically ok Id be coping
  and then thered be an anniversary his death was
  really hard. Id be ill for weeks after the
  anniversary.

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Memories, triggers and crisis

• Awareness of the persons potential trigger
  points, as they are revealed by the individual,
  is critical to understanding when things may be
  harder.

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The power of shame

• At my deepest, darkest inside, I feel to blame
• Jonie
• (Kuafmann, 1992)

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Dissociation and keeping a distance

• When it happened I would imagine myself out of
  my body, up onto the ceiling, looking down at
  what was happeningit was like looking along a
  long tunnel.

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• A natural, protective response to overwhelming
  traumatic experiences, dissociation can become an
  automatic response to stress.
• Kisiel, Lyons (2001)

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Revictimization losing safety
Women survivors, are more likely to experience
unwanted intercourse with both acquaintances and
strangers due to the misuse of the perpetrators
authority than non-victims of CSA. (Messman-
Moore Long, 2000)

• Childhood trauma, particularly sexual abuse, may
  set in motion chain reactions of trauma across
  the life cycle
• (Banyard, Williams, Siegal, 2001)

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Resilience

• Not everyone who is sexually abused seeks
  psychological support
• Not everyone who is abused seems to have
  clinically recognisable levels of distress in
  adulthood

little attention has been paid to survivors who
do not exhibit negative consequences or who
manifest resilience. (Hyman Williams, 2001)
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Surviving

• Lack of resilience does not mean weakness
• Survivors have complex relationships between
  emotional strength and emotional
  hyper-sensitivity
• Some survivors become manipulative to survive.
  We might not like this.

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For the scientists in the audience

• Links between physical stress responses,
  neuro-endrocrinology (especially allostatic load
  imbalance) and the neurophysiology of memory
  might be a useful way to begin to explore the
  physiology of resilience and survival.

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Listening to the Survivors testimony
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How does listening to the following make you feel?

• We were hyper-alert beings, watching for
  shadows, listening for footsteps, sniffing the
  air for a certain fragrance, waiting for the open
  hand or fist to connect to our bare skin in a
  flurry of searing pain.
• For many survivors, even our sleep was disturbed
  by sexual violence and abuse. Our bedrooms,
  instead of being a sanctuary, were traps where we
  were the prey.
• Susan Jeavons

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Developmental psychology, ego strength, and
dealing with what we dont want to hear
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An example from recent research
The prototypical picture of sexual abuse was
weekly genital or anal intercourse by a family
member who was moderately close, lasting between
one and three years. (Kisiel Lyons, 2001)

• Sample of 114 subjects, aged 10-18, wards in
  psychiatric care (ie extreme group).

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The hearers anger

• How could they?
• I used to get so angry listening to what my
  client was saying that Id fantasize about going
  to get the person who did it. The trouble is,
  Id stop listening to my client and get caught up
  in my anger.

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The hearers grief

• I could never view the world in quite the same
  way. I had a reasonably protected childhood.
  All the usual stuff of family rows and stuff, but
  I was physically safe. Now I walk down the
  street looking at people, wondering, are they
  doing it?

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The hearers frustration

• I couldnt understand why she kept going back to
  visit her family. Shed say, I have to go home
  every weekend. I mean, I knew in my head why,
  but in my gut I just wanted to scream TELL THEM
  TO GO TO HELL.

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Rationalizing extent from disbelief to
moderation to acceptance

• Personal defence mechanisms in the face of
  someone elses pain powerful
• Sometimes easier to disbelieve
• Sometimes easier to make simplistic assumptions
  about how survivors should be

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Freuds rationalization
What role does our own shame at not being able to
protect children lead us to consider disclosures
as potentially about fantasy?

• Lolita syndrome ie the seductive child
• Oedipal theory

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Mental illnesses expressed through social
constructions

• Post-modern society obsessed with issues of
  sexual abuse.
• Delusional disorders take societal contextual
  forms for expression.
• Some people who disclose may suffer with
  delusional disorder (attached to false memory
  syndrome)
• Munro challenges this latter point (Munro, 1999)

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Comfort zone

• Fall back to the emphasis on fantasy?
• OR
• Recognize that some folk may have forms of
  delusional disorder, but not at the expense of
  negating the sheer scale of child sexual abuse
  within the population?

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• Survivors of child sexual abuse teach us about
  the limits of ourselves and our humanity.
• Medicalizing survivors as other may make the
  truths they present more palatable, but palatable
  for whom?
• Engaging with survivors may set off our own
  trains of emotional stress.

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References

• Banyard, V., Williams, L. Siegal, J. (2001) The
  Long-Term Mental Health Consequences of Child
  Sexual Abuse An Exploratory Study of the Impact
  of Multiple Traumas in a Sample of Women, Journal
  of Traumatic Stress, 14(4), 697-715.
• Fergusson, D. M. Mullen, P.E. (1999) Childhood
  Sexual Abuse An Evidenced-based Perspective,
  Sage London.
• Hyman, B. Williams, L. (2001) Resilience Among
  Women Survivors of Child Sexual Abuse, Affilia,
  16 198-219.
• Kaufmann, G. (1992, 3rd edn.) Shame The Power of
  Caring, Schenkman Rochester.
• Kisiel, C.L. Lyons, J.S.(2001) Dissociation as
  a Mediator of Psychopathology Among Sexually
  Abused Children and Adults, American Journal of
  Psychiatry, 158(7) 1034-1039.
• Messmann-Moore, T. Long, P. (2000) Child Sexual
  Abuse and Revictimization in the Form of Adult
  Sexual Abuse, Adult Physical Abuse, and Adult
  Psychological Mistreatment, Journal of
  Interpersonal Conflict, 15 489-502.
• Munro, A. (1999) Delusional Disorder Paranoia
  and related illnesses, Cambridge.