A heavy subject, but was intrigued by the surprising premise. Linked to this book via this post.
Highlights and Notes
Indeed, feminists indicted mental health professionals not only for suppressing evidence of the maltreatment of children by men (a “conspiracy of silence” existed) but for male-biased blame shifting.31 According to feminists, their theories, “surrounded by scientific aura,”32 allowed for the systematic suppression and concealment of the sexual exploitation of children.
Feminists rejected this approach outright. As part of their agenda, they rejected any focus on the victims’ behavior, regarding it as diluting the focus on the offenders’ behavior. In short, according to feminists, the offender is always 100 percent culpable for his behavior; they attacked any research or theory that suggested otherwise (for example, research emphasizing the fact that children sometimes comply and/or rarely resist their abuse) as negatively biased.
The feminists involved in this crusade had an interesting challenge to overcome: how to explain the fact that victims themselves said that they rarely resisted the abuse, that they often participated, and that most chose not to report what happened and kept silent about their experiences? The feminist solution was to conceptualize sexual abuse as a violent crime, to treat sexual abuse the same way they treated rape. As Judith Herman explains in her widely acclaimed book Trauma and Recovery , “The feminist movement offered a new language for understanding the impact of sexual assault. . . . Feminists redefined rape as a crime of violence rather than a sexual act.”
IS SEXUAL ABUSE REALLY in the same category of crime as violent rape? According to what victims have said, not really. It is far more complex and multifaceted. But as sociologist Joel Best has noted, such “domain expansion” has important rhetorical benefits,
In fact, at the urging of feminists, all existing scientific research on the nonharmful nature of sexual abuse or on participant victims was either discarded or ignored, thrown out not on methodological but on moral grounds. It was assumed to be “biased against victims” and even “conducted by male professionals committed to the systematic denial and suppression of sexual abuse.” The body of research that subsequently emerged to take its place effectively erased the past. The new emphasis was squarely on violence, force, and psychological harm.
The first wave of research, conducted between the mid-1970s and mid-1980s, involved demonstrating just how damaging sexual abuse was. What occurred was a “cataloguing stage” of all the psychological symptoms and problems victims reported in the aftermath. They were numerous, ranging from mood disorders to relationship and sexual problems, to eating disorders, self-mutilation, and alcohol and drug abuse, to psychosis. These long lists of symptoms were used to justify more professional interest, research funding, and insurance coverage for treatment. In keeping with the new perspective, these studies implied that sexual abuse directly caused these problems, but, as psychologists themselves often noted, this could not yet be proven. According to two influential researchers at the time, Angela Brown and David Finkelhor, although victims reported a wide variety of effects, including depression, anxiety, feelings of isolation and stigmatization, poor self-esteem, a tendency toward revictimization, difficulty in trusting others, substance abuse, and forms of sexual maladjustment, it could not be demonstrated that the abuse was their immediate source.44
For these reasons, this approach met with criticism from some professionals who insisted that the conceptualization of trauma in the PTSD model did not comport with the experiences of sexual abuse victims. In the words of one representative critic, “The circumstances in the prototypal sexual abuse case do not fit the definition of trauma—exposure to a discreet overwhelming event. . . . Most abuse involves the subtle manipulation over time of children by adults they knew and trusted—the trauma model fits in cases of rape by strangers, but for ‘normal’ abuse it doesn’t really apply.”
Framing sexual abuse as a traumatic event and conceptualizing the harm of sexual abuse as a form of posttraumatic stress disorder conferred clear advantages on sexual abuse victims’ advocates. Here was a unified model—accompanied by an associated biology that encompassed a very wide range of distresses, disabilities, and life problems as trauma aftereffects—that could be applied to sexual abuse. One very appealing feature of a traumatic stress model was the unequaled etiological significance it placed on “outside” (external to psyche) trauma; the model located the onus of pathology almost entirely outside the victims. Thus, it supported the victims’ innocence by shifting the focus from their own emotional reactions to, or interpretations of, the sexual contact to the contact itself.
harm in the conditions of the experience itself. As Joseph Davis, a sociologist at the University of Virginia, puts it in Accounts of Innocence, a major appeal of the trauma model was that “it supported the unequivocal moral blame of the offender, including his responsibility for the child’s passivity and silence, by locating the cause of pathology in his complete domination. It helped to depathologize and destigmatize the adult survivor’s symptoms and experiences by explaining them as necessary coping responses.”52 In short, the traumatic stress model did powerful moral and explanatory work; it preserved and encoded victims’ innocence.
Given a fixed probability of a frightening event’s occurring (like a child being sexually abused), most of us are much more likely to get worked up if it is presented as one that we cannot control, that we can easily imagine, and that happens all at once.54 The trauma model of sexual abuse is thus particularly well designed to trigger our fear—certainly much more so than the truth that sexual abuse is often a gradual process in which a confused child is manipulated by someone he or she trusts into performing sex acts the child does not fully understand.
During the 1980s and 1990s, not only did the idea of trauma become attached to a movement (raising attention to the prevalence and harmfulness of sexual abuse), but it may have been the horse that pulled the cart—the idea of trauma proved harm, preserved victim innocence, and helped galvanize professional and social attention to the topic. As Judith Herman states in the opening of Trauma and Recovery, “Without the context of a political movement, it has never been possible to advance the study of psychological trauma.”
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 significance of the victim’s psychological harm in the aftermath.3 There appears to be no direct, linear relationship between the severity of the abuse and the psychosocial difficulties victims experience in adulthood.4 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, and mental health professionals still have not reached a consensus as to exactly why or what precisely to do to help them recover.
Although sexual abuse was not a particularly awful experience for the 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 (although, as memory researchers are well aware, we may distort or misremember some aspects of this experience over time). Sexual abuse, however, becomes traumatic later on.
More recently, two cognitive psychologists, Michelle Epstein and Bette Bottoms, specifically hypothesized that due to the confusing and secretive nature of the abuse, many victims may fail to understand the meaning of the sexual acts committed (and subsequently forget them for periods), but then, at a later point, come to “relabel” the experiences as “traumatic.”11 I believe I am, however, the first to highlight this “relabeling” as characterizing most cases of sexual abuse—to posit that due to the nature of most sexual crimes against children (not painful or forceful) and the age of most victims (under twelve), the majority will fail to understand the exact nature or meaning of these experiences until some point later on in life.
Victims described the point of realization in different ways: “A light went on.” “It was like, aha!” “I said, ‘Oh my God.’” For more than a few it was “like a bomb went off. . . . Holy shit! I was abused!” For many, the realization was a “long, drawn-out process” that slowly built up to a new perception of the abuse. One thing did not vary: only at this point—when victims understood the abuse as such, once they had reconceptualized these formerly ambiguous and confusing events—did the experience become psychologically traumatic and begin to exert its negative effects. And, in stark contrast to our collective understandings of abuse, these effects do not appear to be immediate and direct, and they have nothing to do with any “emotional overload” at the time of the abuse (fear for physical safety on the victim’s part). Rather, they are indirect, part of a process, and they have to do with the negative ways in which victims come to feel about other people and themselves. First and foremost, they feel betrayed.
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.
According to philosophers, psychiatrists, and intellectuals from Aristotle to William James, from Shelley Taylor to Brendan Maher, 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.15 The nineteenth-century memory researcher Frederick Bart - lett may have been the first to name this search: he called it “effort after meaning.”
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.20 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.”21 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.
If, as trauma researchers have stressed for the last twenty-five years, sexual abuse is something done to a victim against his or her will, why would so many victims feel at fault? Some professionals are content to let this remain a mystery.
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.36
Consider the irony: After professionals have worked tirelessly for over thirty years to raise awareness that sexual abuse is common and never the victim’s fault, actual victims still feel alone and guilty.
to develop the self-esteem necessary for sustained ambition,
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.
In the literature on disclosure, a factor that consistently emerges as predictive of whether victims will in fact report their abuse is trauma.
Whether either avoidance or suppression is actually beneficial is unclear. While some research indicates that avoidance is related to better psychological health in victims, other studies show that people who were able to forget their memories totally for a period were actually less well adjusted than those who always remembered their abuse histories.
In 1979, Florence Rush wrote that she “discovered that victims were as shocked and disturbed by the lack of sympathy and acknowledgement of the problem as by the incidents of sexual abuse itself.”32 I do not think much has changed. All victims who participated in my research were asked the same question at the end of our work together: What was the worst part of the sexual abuse? Those who had disclosed the abuse to someone else prior to our interview always gave the same answer. The worst part of the sexual abuse was how other people reacted.
It turns out that there is an inverse relationship between psychological damage and social support. The more support victims receive from others (belief, caring, empathy, attention) the less negative the psychological consequences are. Social support from mothers emerges as one of the most potent predictors of outcome.34
GIVEN THE SIGNIFICANCE of social support for a victim’s psychological health, it is important to consider the reasons why so many people do not support victims—why such damaging reactions as denial, blame, and minimization are so likely to occur. I think a lot of it comes back to the same phenomena: the trauma myth. After thirty years of indoctrination into the idea that sexual abuse is a traumatic experience when it happens, others besides victims have misconceptions about it. Today, most people do not understand sufficiently well the unique nature of child sexual abuse, its underlying dynamics, and the victims’ likely responses.39 Consider again the common reactions we give to victim accounts like those I am exposed to every day: Well, why didn’t the kid tell anyone?
Given the complicated dynamics of the violation—the age of the victim, the fact that the perpetrator is someone he or she trusts and that force or violence is rarely used—it is not surprising that victims go along with it and do not tell for many years. In fact, it makes sense. And given the fact that the psychological damage caused by sexual abuse has little to do with anything traumatic about the abuse when it happened (force, violence, or threat), there is no reason for people to associate the two.
Is it any wonder that so many react with confusion, disbelief, and perhaps even a tendency to blame victims? Nothing the victim says bears any resemblance to the “common and damaging crime” that professionals have portrayed and everyone else has understood over the years. The situation is tragically ironic. By highlighting trauma—thereby emphasizing characteristics of a type of abuse that rarely exists—many mental health professionals advocating for victims to be believed and supported, not blamed or doubted, are fostering the conditions that lead to denial, blame, and minimization in the first place.
What hurts most victims is not the experience itself but the meaning of the experience—how victims make sense of what happened and how these understandings make them feel about themselves and others and subsequently impact their emotions and behaviors.
Acknowledging the truth about sexual abuse has obvious implications for treatment. Harm, the psychological damage that so many victims report as adults, is not a function of trauma at the time of abuse. For the vast majority of victims, the negative effects of sexual abuse are not due to any emotional overload at the time the abuse occurred. Professionals committed to understanding the harm sexual abuse causes need to stop focusing on characteristics of the abuse and start investigating what happens to victims in its aftermath—specifically, the cognitive and developmental consequences of the abuse, that is, how victims cognitively appraise their experiences (make sense of them) and how these appraisals are linked to their subsequent behavior, self-esteem, sexual and emotional development, and relationships with others.
Highlighting the truth about sexual abuse also has clear implications for the recovered memory debate: the question as to whether people can forget and then, later on in life, remember (or recover) their sexual abuse experiences. 20 The answer is, conditionally, yes. If the abuse experiences remembered were not traumatic when they happened, the victim should probably be believed. In fact, it makes sense that these experiences might be forgotten. Why should a child remember them if, at the time they happened, they were not particularly traumatic?21 As I discussed at length, there is almost always a period in which the victim reports a lack of awareness that they were abused and then subsequently reconceptualizes the experience.
All of this being said, in cases in which a victim suddenly remembers abuse experiences that were objectively or subjectively traumatic when they happened (they involved pain, terror, violence, or force), then it is possible the victim is experiencing a false memory—that the abuse experience may not have happened. As Richard McNally and other cognitive psychologists have written about at length, there is no clear evidence that events that were terrifying when they happened can be totally forgotten, that the human mind is capable of wiping out or banishing horrible experiences from conscious awareness.22 Generally speaking, the more traumatic an event was when it happened, the more difficult it is for the person who experienced it to forget about it. Aspects or details of traumatic experiences may be forgotten or distorted (what time of day it was, where the abuse occurred) but not the central part (the abuse).
The implications of accepting the truth about sexual abuse for prevention purposes are crystal clear. Most prevention programs today target children; they focus on teaching potential victims to protect themselves and ward off perpetrators. They do not work very well; indeed, we’ve seen many of these programs in schools today, and kids are still being abused at startling rates.23 The concepts and strategies they would need to be taught are too developmentally complex.
John Kenneth Galbraith, the brilliant economist, famously wrote, “People associate truth with convenience, with what most closely accorded with self-interest and personal well-being, what promised best to avoid awkward efforts or unwelcome dislocation of life. We find highly acceptable what contributes most to personal self-esteem. What we like to believe is not what is true but what is simple, convenient, comfortable, and comforting.”
“The truth gets suppressed not because it is peripheral to major social interests, but because it is so central that as a society we choose to reject our knowledge of it rather than make the changes in our thinking and our institutions and our daily lives that sustained awareness of child sexual abuse demands.”