Psychotherapy with Male Survivors of Sexual Abuse

The Invisible Men

Alan Corbett

• Publisher: Routledge
• Year: 2018
• Topic: Psychology
• eBook ISBN:
  9780429918308
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book provides the long history of male sexual abuse based on the author's extensive clinical experience of working with children and adult victims of sexual crime. It presents several sexual abuse studies, focusing on the challenging art of psychotherapeutic treatment.

CHAPTER ONE


The invisible men: a brief history of male survival

“I was invisible,” says “Barry”, his voice little more than a whisper. “No one saw me when I was growing up. There were so many of us I think my mam forgot about me a lot of the time. Apart from him. He saw me, all right.”

Barry is referring to his parish priest in Ireland, the man whose sexual torture of him began at such an early age that Barry cannot recall a time in his life when he was not being abused. He looks barely visible, and seems more like a ghost than a man. His skin is pale, his body skinny and malnourished. I am used to working with male survivors of sexual abuse whose trauma remains hidden behind a veneer of apparent health, robustness and vigour, men whose outward demeanour offers no clues as to the horrors they have suffered. Barry is not like these other survivors, has no facade with which to cover his enduring pain. His defences are paper-thin and I marvel at how he is able to survive in this world. He is in his early thirties but looks much older, his skin dried and thinned by decades of cigarettes and alcohol. He has not worked for many years, and is currently scraping an existence on sickness benefit. He lives in a shared house, and spends most of his days in his room, his mind tormented by memories of the abuse that dominated his childhood. He is the personification of the word “victim”. To call him a survivor would be to miss something completely evident about the way in which sexual abuse has drained all life from him.

My job is to assess Barry as part of his compensation claim against the Catholic Church and the Irish government, the two institutions most culpable for the crimes committed against him. He is one of many victims of this one priest who, when abuse was suspected or disclosed, was moved from one parish to the next, his abuses never defined as crimes and the actions of his employers enabling him to exploit another group of boys in another village or town. The work of getting from Barry a cogent narrative of his childhood abuse is easy. It is a story he has rehearsed in his head for many years and one that is all too credible. The most difficult task facing me now is deciding how to end our session. After two hours of outpouring the most unsettling and disturbing details of his abuse, I wonder if Barry is feeling as sick as I am. How, I wonder, will he be able to end this session and resume the barren, despairing, and empty life he has described? I tell him that I think he needs therapy. I remind him that he is entitled to free therapy, therapy that the Irish government will pay for. He smiles, sadly, and says he has tried it before. “But I had to stop. There was only enough money for two years. Two years! I was only getting started, and then I had to stop; I had to go back to my life. It’d take me a lifetime to say it all.”

Eventually Barry was able to start low-cost therapy with a colleague of mine, someone used to working with men whose experiences of childhood abuse and, in some cases, adult rape, had imprinted upon them a translucence, an aura of invisibility. At first the work appeared to be going well, but I was unsurprised to learn that after a year Barry had stopped coming, the strain of revisiting his years of abuse becoming simply too much for him to bear. His therapist worked hard to keep Barry in treatment, trying to contain him through times of crisis when his alcohol use escalated and his capacity to simply get to the consulting room ebbed away. He vanished back into the state of invisibility he had described to me, a state that had left him vulnerable to abuse as a child and enabled him to slip through the cracks as an adult. Despite the prospect of the kind of long-term therapy he so clearly needed, the reality of his story and his self becoming visible were, perhaps, too much for him to bear. The safety of invisibility seemed to provide Barry with the refuge he yearned for, a refuge in which his suffering would continue, unheard and unseen.

A crime without a history

The invisibility of sexual trauma comes in many different forms. Some survivors, like Barry, occupy a fragile, wraithlike place in the world, their sense of self emaciated by neglect and further atrophied by abuse. Their trauma is etched onto their being to the point where we have to make them invisible—the agony with which they live is too much for us to see. There are other survivors who have managed to assume a pretence of pseudo-normality, whose histories of abuse are buried beneath layers of competency, internal damage hidden behind masks of high-functioning success. This too makes them invisible. We look at them and see nothing of the traumata that underpin their manic, inauthentic facade. This is possible partly because we do not wish to see. Visibility is not just dependent on what is seen, it relies on our capacity to look.

During the writing of this book, funding for London’s only clinic specialising in working with male victims of sexual assault was cut. While this was a deep, life-changing shock to its clients and workers, the possible extinction of this well-established and highly regarded service did not trouble the headlines. There were no visible signs of protest, no marches, and no hunger strikes—just one online petition. What, I wondered, would have happened if there was only one clinic in London for female victims of sexual assault and it was threatened with sudden closure? I would hope and expect there to be mass protests, voices galvanised against such an appalling injustice, and appeals at the highest levels of government for sanity to prevail. How, then, is it possible for the killing-off of a service for men to be greeted with apathy, indifference, and near silence? How and why are boys and men who have been sexually abused rendered invisible?

There is something deeply problematic in how we consider the sexual abuse of boys and men. Scarce (2001) describes the rape and sexual assault of men as “a crime without a history”, and it remains a phenomenon shrouded in the secrecy, shame, and fear that once characterised all forms of sexual abuse. The later part of the twentieth century saw the scales fall from our eyes in relation to sexual abuse, with the appalling experiences of children across the centuries finally being validated and given a place in both society and psychohistory (deMause, 1974). And yet if we dare to speak of the rape and abuse of men, we speak in a whisper. While there still remains much work to be done in ensuring full legal justice for female victims of abuse, the work of feminist, social, and clinical action over the past forty years has ensured that a woman talking today about her abuse, as a girl or as a woman, is significantly more likely to be believed by those around her than twenty years ago.

Such a revolution has not happened for men. As will be demonstrated in this chapter and beyond, men are less likely than women to be believed if they summon up the courage to speak of their experiences of sexual abuse. This is an extraordinary finding, given what we already know about how hard women can struggle to have their experiences of abuse believed. There remains a collective societal blindness not only towards the experience of sexual abuse itself, but the resultant emotional needs of its male victims. In thinking about how we have fallen into such a dangerously split view of gender and abuse, I have considered some of the wider areas of denial enacted in such areas as the media and the criminal justice system, but have chosen to focus predominantly on the psychotherapy world. It is here where I hope this book may effect most change, loosening the grip of overly gendered attitudes towards sexual trauma, and allowing us as individual clinicians and representatives of training institutions to think more insightfully about the ways in which we invite male survivors into our consulting rooms.

Language

A few words first about terminology. “Sexual abuse” is a term that fails to capture the range and barbarity of the acts it seeks to describe, let alone the depth of suffering inflicted upon its victims. Since most of the clinical work with male survivors I will describe throughout this book took place in the UK (with some of the work taking place in the Republic of Ireland), I have used as my starting point the description found in the UK Government’s guidance for professionals—Working Together To Safeguard Children—in which sexual abuse is defined as:

Forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetration (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse (including via the internet). (DCSF, 2010, p. 38)

As we will see, this definition just about scratches the surface of the kind of experiences visited upon some boys, and does not say anything about the range and impact of abuses experienced in adult life. It is, though, a starting point, and one that I will seek to build on through a mixture of theory and practice. Alongside a bringing together of various theoretical strands, I will try to convey a fuller narrative of what sexual abuse is, the kind of visceral attack on both mind and body that it represents, and the particularly gendered responses it can generate in male survivors. The most effective way to convey the impact of sexual abuse and how to work with its effects therapeutically is to write about cases. In order to protect the confidentiality of the men I have worked with, I have disguised thoroughly every detail pertaining to them, to the point where the vignettes I have used should be viewed more as fictionalised accounts in which actual biographical details have been blended and blurred to the point of non-recognition. I will mainly use the term “male survivors” to describe the men I work, or have worked, with. I will occasionally use the word “victim”, and have found myself using it mainly to describe those men for whom embarking on a psychotherapeutic process feels like an insurmountable hurdle, those for whom sexual trauma has had a crippling and potentially fatal impact.

Hidden in plain sight

Little about sexual abuse is new and the sexual abuse of boys and men is a phenomenon with a long but little-documented history. The means of abuse may evolve over time as abusers learn to make perverse use of the internet, social media, and global networking of paedophilia, but the process remains basically unchanged. Jimmy Savile’s use of celebrity as a visible cloak (or to use the title of Davies’ 2014 study of Savile’s perversion being “hidden in plain sight”) with which to hide his abuse of children and vulnerable adults is not a purely modern phenomenon. In 1895 a Manchester newspaper uncovered the crimes of Gilbert Kirlew, a well-known and highly respected bastion of decency (Pavlakis, 2014). His fame, much like Savile’s, was based partly on his very public acts of social good. He was at the vanguard of the new social movement to take poor children from the gutters into secure homes. It was at one of these homes that he was found to have been systematically sexually abusing the homeless and neglected boys he was supposedly giving refuge to.

The psychohistorian Lloyd deMause describes the story of childhood as “a nightmare from which we have only recently begun to awaken. The farther back in history one goes, the lower the level of child care, and the more likely children are to be killed, abandoned, beaten, terrorised, and sexually abused” (1974, p. 1). He goes on to describe the boy in antiquity living “his earliest years in an atmosphere of sexual abuse. Growing up in Greece and Rome often included being used sexually by older men … In Crete and Boeotia, pederastic marriages and honeymoons were common. Abuse was less frequent among aristocratic boys in Rome, but sexual use of children was everywhere evident in some form. Boy brothels flourished in every city, and one could even contract for the use of a rent-a-boy service in Athens. Even where homosexuality with free boys was discouraged by law, men kept slave boys to abuse, so that even free-born children saw their fathers sleeping with boys” (p. 43). Intercourse with castrated boys was regarded as providing higher levels of arousal for men, with infants being castrated at extraordinarily young ages to be used in brothels. DeMause goes on to trace the history of childhood sexual abuse until the twentieth century, revealing a highly disturbing acceptance of the sexual objectification of infants, children, and adolescents of both genders.

Legal definitions

The Sexual Offences Act 2003 (England and Wales) defines rape as the non-consensual penetration of the vagina, anus, or mouth with a penis. The separate offence of sexual assault by penetration, which carries the same maximum sentence, covers attacks involving other objects. This legislation differs from that of other countries (including Scotland, Sweden, and the USA) that avoid gender-specific pronouns. Scotland’s Sexual Offences Act in 2010 gave, for the first time, a legal definition of male rape, recognising that men, as well as women, could be victims. Despite its gendered definition of rape, changes to the England and Wales Criminal Justice Act enabled the jailing of a man for life in 1995, for the attempted rape of another man. Change is happening, but at a painfully slow pace.

How the law conceptualises abuse does not simply have legal implications, it affects social and cultural attitudes. One common example of this is the assumption that a sexual assault cannot be regarded as a crime if the victim has an erection during the attack. Male erectile response is involuntary. A penis can become erect due to stimulation, not necessarily through arousal. The failure to understand this can be profoundly distressing for the victim who struggles to process the contradictory messages transmitted physiologically and psychologically: the mind screaming “no” and the body seeming to scream “yes.” This confusion can also be seen in what in the United States have been referred to as “made to penetrate” cases, where male rape victims are made to engage in the penetration of a woman or a man. In many of these cases the male victims are under the influence of drugs or alcohol, or being held in life-threatening positions, and struggle afterwards with the guilt of what their body has done, against their conscious will.

Prevalence of sexual abuse

According to a study published in Clinical Psychology Review (Pereda et al., 2009) that examined sixty-five studies from twenty-two countries, the global prevalence of child sexual abuse has been estimated at 19.7 per cent for females and 7.9 per cent for males. The highest prevalence rate of child sexual abuse geographically was found in Africa (34.4 per cent), primarily because of high rates in South Africa. Europe showed the lowest prevalence rate (9.2 per cent) and America and Asia had prevalence rates between 10.1 per cent and 23.9 per cent. In the past, other research has concluded that in North America, for example, approximately 15 to 25 per cent of women and 5 to 15 per cent of men were sexually abused when they were children (Finkelhor, 1994; Gorey & Leslie, 1997).

In their study of self-reported childhood physical and sexual abuse in a general North American population sample of men and women, Briere and Elliott (2003) uncovered an incidence of 14.2 per cent of male subjects reporting sexual abuse as compared to 32.3 per cent of female subjects. Physical abuse was reported by 22.2 per cent of men, as compared to 19.5 per cent of women. Of subjects who had experienced one type of abuse, 21 per cent also experienced the other type, and both types were associated with subsequent adult victimisation. The gender breakdown of abusers of female victims was generally in line with the sexual abuse literature (93 per cent had been abused by at least one male, and 9 per cent had been abused by at least one female), whereas the data on perpetrator gender for male victims represented a newer finding. Of males who had experienced abuse, 39 per cent reported having been sexually abused by at least one female, and 70 per cent described sexual abuse by at least one male. Finkelhor (1994) extrapolated from available retrospective report studies that approximately 20 per cent of prepubescent boys who had experienced sexual abuse had been abused by a female. Mendel (1995) found that 60 per cent of his clinical sample of males reported childhood sexual contact with an older female. In 2012/13 the police in England and Wales recorded 5,156 offences of rape of a female child under sixteen, as compared to 1,138 offences of rape of a male child under 16. They also recorded 4,171 offences of sexual assault on a female child under thirteen as compared to 1,267 offences of sexual assault on a male child under thirteen (Office for National Statistics, 2013).

Under-reporting issues

Most disclosures of childhood sexual abuse take place some time, often years, after the abuse has occurred (Allnock & Miller, 2013). Girls are more likely than boys to disclose sexual abuse (Hanson et al., 2003; Tang et al., 2008; Terry et al., 2010). Research figures estimate that in the UK 11 per cent of the male population have suffered sexual abuse as children (Cawson et al., 2000), while 3.4 per cent of the male population have experienced sexual violation in adult life (Finney & Britain, 2006). These figures are, of course, subject to under-reporting issues. Prevalence estimates of adult sexual assault of men vary widely due to methodological inconsistencies among research studies (Peterson et al., 2011). The generally lower proportion of male as opposed to female victims of sexual abuse may not be completely accurate. Fewer than one in ten male–male rapes are reported (Crome, 2006). Under-reporting may be particularly prevalent for men because of the fear they will be labelled as homosexual (if the abuser was a man) or weak (if the abuser was a woman). Male victims of sexual abuse are also less likely than female victims to seek psychotherapeutic help at some point in their lives, although they are more likely than non-abused men to seek therapy for issues that seem unrelated to abuse (Gartner, 1999). Sexual abuse of girls is more common than abuse of boys, but it also more universally condemned when it is discovered (Groth, 1979).

Given the global prevalence of male abuse, the international silence about it is striking. Sivakumaran (2005) sees this silence as a communication of social homophobia. Society considers any sexual contact between men to be indicative of homosexuality, regardless of any element of coercion. Given the continuing prevalence of homophobia in society, this translates into a “taint” on the part of the victim of male rape. Holmes et al. (1997) suggest a conflation of two broad factors that lead to an under-reporting of male abuse: male victims are relatively unlikely to disclose their experience of childhood abuse, and (as a coping strategy) they deny the impact of sexual abuse on their lives. Professionals fail to hypothesise that their male c...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgements
• About the Author
• Series Editor’s Foreword
• Introduction
• Chapter One The invisible men: a brief history of male survival
• Chapter Two Toxic masculinity: the impact of sexual aggression upon the male psyche
• Chapter Three Numbers: working with sexual compulsion
• Chapter Four There is no such thing as a survivor: forensic psychotherapy and the abused/abuser split
• Chapter Five On not knowing the colour of a patient’s eyes: working with profound depression
• Chapter Six Dying to be a woman: grievances and attacks on gender
• Chapter Seven Starving for two: working with embodied trauma
• Chapter Eight Physician heal thyself: the impact of trauma upon the clinician
• Chapter Nine The disunited states: working with dissociation
• Chapter Ten A crowded marriage: working with couples
• Chapter Eleven Becoming visible: on seeing and being seen
• References
• Index