Childhood Sexual Abuse

 Adult Victims of Childhood Sexual Abuse

Adult victims of childhood sexual abuse often do not remember the trauma of the abuse. The trauma of the abuse expresses itself in inhibitions in the person’s ability to have an intimate relationship. “Flashbacks”: memories or bodily sensations associated with the abuse intrude themselves into consciousness and are disorganizing. The child looks to the molester for love and affection. The molester looks at the child with lust and sadism. Identifying with the molester is one way of coping with the trauma of the assault. The child subsequently looks at themselves thereafter as a worthless object. Tracing the origins of these flashbacks are a vehicle to helping the person remember the abuse. Remembering the trauma of the abuse, of what he/she actually felt during the assault and appreciating the effect the trauma has had on his/her personality can be an enormous vehicle for repair and being able to lead a happy life.

Dynamics of Childhood Sexual Abuse

To promote the integration of dissociated states, the motive for dissociation,  the lack of a sense of safety and the tendency of the victim to blame herself are three issues frequently met with in the analysis of people suffering from childhood sexual abuse. I use her throughout this paper only because many of the victims are women. The paper addresses these three fundamental issues.

Integration of Dissociated States

The first issue I want to address is the integration of dissociated states. DSM IV-R  defines dissociation as a disturbance in the normally integrative functions of identity, memory, or consciousness. If this occurs primarily in  identity, the person’s customary identity is forgotten and a new identity may be assumed or imposed. Dissociation augments repression and splitting. It is an elaboration of splitting leading to the constellation of mental states. It develops as a primitive, adaptive response of the ego to the overstimulation and pain of external trauma and may result in disturbances in awareness, memory and identity. This defense results in a vertical split stimulating  corresponding mental states  alternately enacted but not integrated. Dissociation exists on a continuum with multiple personality disorders representing the most extreme form of this kind of process

Many victims of sexual molestation have suffered a trauma of monumental proportions in terms of the effect it has on later personality development. The molestation’s causal relationship to many of the person’s later difficulties qualifies it as a traumatic neurosis for some people. It also qualifies as a traumatic neurosis in that like other traumas sufficient experience of the event failed to occur to allow symbolization and then forgetting and repression in childhood.

Forgotten experience is generally relegated to the preconscious where retrieval can occur by introspection, or to the unconscious where retrieval requires the analysis of defense. There is a horizontal split in the ego.  In both cases, full articulation of the events in consciousness occurs before forgetting takes place. The situation is different with trauma. Traumatic events present the mind with too many stimuli to experience and think about. The mind splits off or dissociates unsymbolized experience to avoid mental  dissolution before  it has been able to symbolize it.

For example, when Father yells at Baby, Baby initially experiences her body being assaulted. An image of Father develops, if the yelling is not traumatic. This image can then evolve into a thought of Father yelling and Baby can compare that thought  with other more benign images of Father. She can thus soothe herself. Adequately symbolized experience relegates Father’s yelling to the preconscious  and forgetfulness  or to the unconscious and repression. However, traumatic yelling confronts the mind with too much stimulation, foreclosing  experience and articulation. This results in a splitting off a dissociated mental state as a somatic memory; a sensory experience devoid of images or words. This forms the basis of a dissociated state. Representational functioning fails  in trauma.

The dissociated state returns with particular force when it is first recovered. Some accidental occurrence will often trigger this recovery.  In the case presented below, associations to a dream in the fourth year of her analysis led to recovery of memories of being raped. Recovery of dissociated states often engenders the  experience of flashbacks and somatic memories where the patient relives the childhood sensory experience. This reliving often has a terrifying reality  and past can become confused with present. Lack of prior symbolization has deprived the memories of a structure and context in time.  An example of such a state would be extreme pain in the vagina that causes the patient to double up. She relives the experience of being penetrated as a child, but lacks words or images to attach to the experience. The patient needs help in bearing the distress and owning the memory if thought about the experience is to evolve. Bearing the distress facilitates  a sensory experience  being brought to a level of cognition and formulated thought.

Recovery of the trauma stimulates a pattern of alternating ego states  where the person alternately experiences themselves  as being molested  or  unprotected  and then denies the events. During states of denial, the person may function quite adequately, albeit without the knowledge of previously conscious mental states. Treatment then becomes a matter of either helping the patient to put words to and make sense of the trauma, or analyzing their resistance to facing the trauma.

The Sense Of Safety

The second issue I want to address is the lack of a sense of safety in victims of childhood sexual abuse.  A mother who ministers to and contains the infant child’s  needs imbues her with a feeling of safety. Mother provides a feeling of protection. Sufficient connection with her imbues the child with a life long belief in her significance and an illusion of being omnipotently protected. The internally experienced background mother  contains the child’s emotions, transforms them into something manageable and returns an improved product to the child. Adequate containment as an infant imbues her with confidence about coping with her emotions.

Childhood sexual abuse often shatters the sense of safety, flooding her with uncontrollable, unspeakable emotions.  Recovery of the memory of the trauma in treatment revives early experiences of being unprotected.  Recovery of the trauma for some patients may also bring with it increased dependence on the analyst. This arises because: 1. The person feels unprotected on the outside as they recall and relive in the transference how unprotected they were by their parents. The patient frequently feels that the molestation happened to begin with because the parent didn’t sufficiently protect them or prepare them for the dangers of the world. 2. They also feel unprotected on the inside because they feel unable to repress the memories that come up with increasing force. They feel molested by their feelings and demonstrate a fundamental lack of confidence in their ability to regulate affect. There is a lack of an adequate external and internal provider of safety. The patient frequently deals with this lack of safety by clinging to the analyst.

The patient clings to external background  mother because the internalized representation is insufficient. The patient derives an illusion of safety from the physical proximity of the analyst. The failure to adequately internalize a background maternal presence often results in an inability to repress. Such a patient may cling to the analyst  because the analyst can provide words for the wordless experience that the patient senses will ultimately help them master the trauma.

The Dilemma Of No Longer Being Numb

Patients often experience themselves as unprotected and in danger as they move toward mastery of the dissociated trauma. They sometimes feel that they have had their defenses taken away by the analyst and given nothing  in its place. This contributes to seeing the analyst as a dangerous person. This fear of the analyst  and of acknowledging the dissociated state needs interpretation, to mitigate subsequent impulses toward self destructive acting out.

Learning To Forgive Oneself

The third issue I want to address is the analysis of self blame. Victims of childhood sexual abuse often blame themselves for what happened. They do not realize that they were trapped, without options and had no choice but to act as they did. This inability to forgive themselves is at the core of their chronic depression, self hatred, low self esteem, rejection of their bodies and penchant for suicide.

Before a person can forgive themselves, it is often first necessary to uncover that they do  blame themselves for the event. The self reproach is often unconscious. One may offer a more benign explanation of events only after one uncovers that they do indeed blame themselves.

Small children feel sexual acts primarily as aggressive acts. There is often a lack of a coherent self and a sense that whatever fragments of self do exist, feel degraded, unacceptable and worthless. There are multiple determinants for the tendency to turn the aggression for the molester onto the self and blame oneself for the event. 1. There is a tendency to identify with the aggressor. 2. They turn aggression on themselves rather than risk threatening a vitally needed relationship. 3. They need to ascribe meaning to a meaningless act of violence.

Why does the child victim come to blame herself for the sexual assault and not rage at the molester? Ferenczi addresses this question in his article “Confusion of Tongues.”  He asserts that the child looks to the adult for tenderness and the adult molester looks to the child with passion and/or sadism. This creates confusion in the child that she deals with by splitting her personality.  To paraphrase Ferenczi, one would expect the first impulse and the emotions of children after such violence to be that of reaction, hatred, disgust and energetic refusal. ‘No, I do not want it. It is much too violent for me. It hurts. Leave me alone!’ The child would have reacted like this or something similar if enormous anxiety hadn’t paralyzed her.

These children feel physically and morally helpless. There isn’t sufficient consolidation of their personalities in order to be able to protest, even if only in thought. The overwhelming authority of the adult makes them dumb and can rob them of their senses. “The same anxiety, however, if it reaches a certain maximum, compels them to subordinate themselves like automata to the will of the aggressor, to divine each one of his desires and to gratify these; completely oblivious  of themselves, they identify with the aggressor”.  Through identification, he disappears as a part of external reality and becomes intra instead of extra psychic. The child succeeds in maintaining the previous situation of tenderness to the molester but hates herself. She now treats herself with the same sadism previously expressed by the molester. When she attacks herself for not having fought harder she is demonstrating a lack of connection with her own helpless rage and is enacting a sadistic attack on herself. They behave as if they are largely  emotions and conscience there is little mind to mediate experience.. Modern psychoanalytic work with trauma supports Ferenczi and  finds there is “little mind” during traumatic overstimulation. This is adaptive response to trauma.

Recovery Of The Rage

The patient gets in touch with the rage at the molester for having damaged them and the rage at the parents for having failed to protect them following working through of the rage against the self and the identification with the aggressor. She feels the rage as overwhelming and this is the most frequent stimulus for experiences of fragmentation, fears of mental  dissolution  and impulsive suicide attempts. These patients often inadequately articulate or symbolize the rage when they first discover it.  Consequently, there is a tendency on the part of the patient to want to act on their feelings. This tendency needs  restraining.

Reclaiming The Body

The person may need to disown her body because she blames herself for the rape and molestation. She does not realize that she was trapped, without out options and had no choice but to act as she did. Once she can begin to own that she had a body and  sexual needs, her hatred for and shame about the rape and her body begins to diminish. Once one forgives oneself for participating in the molestation, one has less  a need to dissociate the body. Acceptance of the body ushers in acceptance of the need to love and be loved again. Fears of loving and trusting people often occur during this period.

Learning to love again

Physical abuses are also damaging. “‘Soul murder seems to be more severe in girl incest victims, for the sexual penetration is perceived as a destructive invasion of the innermost body, the ultimate invasion of privacy, much worse than verbal abuse or physical attacks on the body surface.” As one young woman described it, ‘I always thought I could grow up and get away from all the beatings and criticism and then be free to live. But when my father overpowered me and put his penis in my vagina, it was the end. All hope was gone. My spirit had been killed. And mother did not care. That’s when I cut my wrists.”

Perhaps it is the degree of violence present in the assault that is important. Some believe that the more violence present in sexual abuse, the greater the damage. Moreover, that the more dominance and violence the perpetrator expresses, as in the extreme situation of rape, the more obvious is the exploitation and disregard. Yet, even in rape, the devastating consequences seem due more to the violence of the perpetrator and the relative helplessness of the victim than simply to the sexual aspects of the attack itself. Even in “milder” cases of sexual abuse, that is, where elements of violence, force, or cruel disregard for the feelings of the child are less prominent, the degree of trauma is related to the discrepancy between the intensity of the noxious stimuli and the ability of the child’s mind to cope. Moreover, sexual molestation between family members is worse than by strangers since you are betrayed by those that you depend on for love.

In my own work, I have not seen the confusion of sexual identity and the disruptions of ego functioning in victims of physical abuse that I have seen in sexual abuse.  There is not the dissociative states concomitant with remembering of the trauma in physical abuse as there is with sexual abuse. In my limited sample, the people who have been physically abused did not seemed as damaged. However, I have not worked with holocaust or torture victims. So, another issue  is: is physical abuse the same as sexual abuse? You might see deindividualiztion and dehumanization in both, but are they the same syndrome?

Transference

I want to conclude with some comments on the love for the analyst that emerges in the treatment of victims of childhood sexual abuse. Transference is usually thought of as a regression, repetition and displacement of an old relationship that the patient once had. However, at times, the patient does not seem to be repeating an old relationship, but enacting a relationship that he has never had before. The transference is to the fantasy parent he didn’t have. This transference to the fantasized parent has to be differentiated from the new “real” relationship with the analyst.