On Childhood Sexual Abuse
By Maria Minicucci, PhD
For the past 25 years I have been involved in counseling, group work, workshops, training, supervising, and writing in the United States and Canada. The one issue that has been the most challenging to me as a therapist, a woman and a political activist is this: childhood sexual abuse. In my professional experience, women (and, more recently, more and more men) who have experienced any form of sexual abuse prior to the age of 18 inevitably have experienced the most profound form of woundedness. The therapist can further jeopardize the healing process of the incredibly enormous and insidious ramifications of sexual abuse.
The impact of being sexually abused infiltrates every part of one’s person. At the moment of violation, every child must make a crucial decision: will I, can I survive this? The magnitude of this trauma literally places a child in a life/death situation. Ironically, choosing to survive carries with it its own set of consequences. On the one hand, the child who chooses to survive does so by accessing his or her ability to be ingenious, brave, powerful, and trusting in one’s body during this ‘invasion,’ losing memory of the abuse, developing and activating other parts of the ‘Self’ to rely on for protection and solace. On the other hand, as creative and wise as these strategies are, and there is no doubt that they are all of that, the impact on the Adult Self is inevitable and unmistakable.
First and foremost, the act of an adult imposing sexual violence on a child results in a particular form of devastation. The child could forfeit his or her capacity to formulate age appropriate boundaries, in terms of knowing when and how to guard oneself, and when to be open to certain people and situations. As an adult, trying to function in the world is fraught with an underlying sense of terror on a daily basis. This terror affects and, in most instances, warps one’s sense of reality and, ultimately, how one interacts in every relationship. The surface signs are that of mistrust, emotional unavailability, and a fierce need to control everything and everyone. On the surface, it appears to family, friends, colleagues and romantic partners that this person is incapable of being a ‘responsible’ adult. In fact, based on the degree of terror from within, the outward manifestations of wariness, emotional cautiousness and vigilance about the external world are appropriate. In fact, just on the issue of the fierce need to control, it is simply not a matter of a bad habit or a personality defect which needs to be changed. For the adult who has survived sexual abuse, control is again an issue of life/death: any loss of control, real or perceived, resembles a life-threatening predicament. Relationships that require intimacy can place the survivor in severe emotional and psychic jeopardy. Often there is a struggle between absolute avoidance of intimacy or diligent attempts to be in that place. The reality is that, having been robbed of the capacity to put up and remove boundaries, the imminent presence of intimacy generally produces recoiling from such a dangerous undertaking. Both the survivor and the other person suffer a sense of loss and deprivation. Both, without the awareness of the underlying origins, suffer confusion, anger, resentment and blame. The survivor is often placed in the position of reinforcing feelings of defectiveness, inadequacy, and self-loathing.
Cultures based on violence and control exacerbate incidences of sexual abuse
A lifetime of self-hatred manifests itself in a myriad of ‘socially unacceptable’ behaviors. Not every survivor of sexual abuse develops any or many of these behaviors, nor are others exempt from exhibiting them. It is important to stress that, given the prevalence of sexual abuse, it is incumbent upon all of us to become aware of these behaviors ó a culture predicated on violence and control exacerbates the incidences of sexual abuse. Even more importantly, we need to perceive these behaviors as appropriate and necessary coping strategies. The revictimization of survivors occurs every time friends, family, spouses, lovers and mental health providers place their behaviors in the categories of ‘unreasonable, crazy; deviant or criminal.’ Common but not inevitable manifestations of sexual abuse include: substance abuse, chronic depression, prostitution, self-mutilation, dissociation (aka multiple personality; dissociative disorder), addiction to perfection. Some of the physical consequences can be cancer (often of the throat and reproductive system), ‘chronic fatigue,’ fibromyalgia, Candida (in women), temporary bouts of blindness or deafness.
The potential outcome of having been violated is quite plausible given the knowledge of its impact. For example, leaving one’s body (dissociation) as a way of surviving the pain of being violated is a creative choice. The trade off initiates the process of splitting off into fragments of the self. Leaving oneself in a state of fragmentation results in varying degrees of insecurity, self-hatred, the need to manipulate others, susceptibility to depression, debilitating feelings of helplessness and powerlessness.
The ability to submerge the trauma deeply and thoroughly is, initially, another way to survive. In the long run, having the trauma deeply imbedded in every pore, cell, tissue, muscle undermines all kinds of possibilities for one’s overall sense of well-being. More specifically, locking in the trauma so effectively generally provokes more of the physical conditions I mentioned previously.
Developing other parts of the Self to cushion against feeling utterly bereft of care and safety has been erroneously referred to over the years as Multiple Personality Disorder. MPD has alternately been a source of intrigue and pathology among mental health professionals. Since there has been more consciousness raising about sexual abuse, MPD is now often referred to as Dissociation, somewhat pathological, somewhat a reasonable response to personal endangerment. Nevertheless, the fact remains that straddling the lines between ‘mental illness’ and coping offers insufficient validity for the survivor whose reality must incorporate the existence of several selves.
This brings me to the other objective of this article: how the mental health providers can place the survivor in further emotional jeopardy. My own experience is that at least half of the clients who began therapy were totally unaware that they had been sexually abused. These occurrences are frightening and overwhelming: about 8 in 10 women (6 in 10 men) have been sexually abused prior to the age of 18. I was among many clinicians who, upon such disclosures, had to initially fly by the seat of our pants in order to carry out our responsibilities to our clients to the best of our ability. Some of the ways in which I have observed this trial and error approach not only exacerbates revictimizing clients, but also impedes the potential for sexual abuse to decrease.
Some of the ways in which this occurs are: not allowing clients to determine their own experience; believing that the client is fragile by clinging to the ‘therapeutic’ notion that the manifestations of sexual abuse are indeed signs of a ‘mental illness,’ perceiving the client as only the ‘wound’ rather than acknowledging that woundedness was inflicted upon her or him, and by dictating a standardized, ‘proper’ healing process irrespective of the client’s needs. Many therapist responses are based in, either the sheer incredulity of such unseemly and unnatural acts, or the personal discomfort provoked by such ‘shocking’ descriptions of what were supposed to be ‘normal’ childhood experiences. Nevertheless, if we, as mental health providers, are willing to carry on responsibly, we need to make deliberate and concerted attempts to become informed, skilled and committed to the intolerance of such violence in our society.
I cannot emphasize enough that the self-destructive, self-defeating behaviors associated with sexual abuse are not rooted in weak, faulty or inadequate human beings. They are a direct outcome of forms of violence imposed upon unsuspecting, unwilling and unprotected children. And, as long. as we remain a society which is reverent to values and standards which are, without question, anti-life, we participate in condoning deliberate acts of spiritual annihilation.
I want to celebrate the durability of the human spirit. Far from being fragile, as we tend to believe, survivors who embark on a journey of healing from sexual abuse disprove the theory that this is a permanent affliction. Survivors, who face overwhelming fears of disintegration from the pain, rage, and illusions, are transformed from people who have been stopped in life to people who are developing a sense of wholeness, to move from surviving to thriving, to trade off feelings of despair for ones of confidence and vitality.
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