Casualties Of Childhood

A Developmental Perspective On Sexual Abuse Using Projective Drawings

Bobbie Kaufman, Agnes Wohl

• Publisher: Routledge
• Year: 2013
• eBook ISBN:
  9781134855612
• Print ISBN:
  9781138004924
• Subtopic: Entwicklungspsychologie

Against the backdrop of powerful case vignettes and their accompanying House, Tree, Person and Kinetic Family Drawings, the discussion focuses primarily on the essential link between childhood sexual abuse and specific developmental problems. Given that sexual abuse is commonly directed toward latency-age young people, it is imperative that this connection be given greater emphasis in the literature. The book represents an important step in that direction. In sum, the authors bring to life the full dimension of sexual victimization, its meaning and consequences for the individual, the family, and by extension, the society. For therapists of all persuasions, it is a much-needed resource.

CHAPTER 1

PARADIGMS OF TRAUMA AND SEXUAL ABUSE

Neither child sexual abuse nor the specific category of incest are diagnostic categories. They are not included in the DSM-III-R although some have argued that just as Post-traumatic Stress Disorder has its own particular criteria and diagnostic code, so should child sexual abuse. A number of professionals, in fact, have identified a designated set of behavioral indicators and symptoms, labeling them Child Sexual Abuse Syndrome. Within this construct, sexual abuse is viewed as an external event that triggers an internal process with a range of symptoms and characteristics, which are predictable regardless of other influencing factors.

We subscribe to the perspective that incest is an external event which is incorporated within the context of the child’s premorbid personality, stage of development, physical and psychological constitution, experience of previous traumas, and familial environment. The identification of the perpetrator and the family’s and society’s response (i.e., courts, police) to the abuse are also significant factors. It is the interweaving of these components that determines the symptom picture and future direction of the youngster’s developing personality.

IS SEXUAL ABUSE HARMFUL?

Yates (1982) reviewed literature written in the 1960s and 1970s concerned with the question of whether or not the incestuous relationship is deleterious for the child. Stating that it may be erroneous to assume that the child has been negatively effected, Yates concludes that the abuse may provide a source of nurturance not otherwise available to the child. She maintains that the child may miss opportunities to disclose the abuse partly because of a reluctance to give up the gratification received from the special nature of the connection.

Others (Butler, 1978; Forward & Buck, 1978) believe that neglected youngsters may derive positive benefits from the incestuous relationship without which an environment of desolation would continue. They espouse that the incestuous contact, which may be the only nurturance, affection, or attention the victim has ever known, can function to help the child feel loved. Shengold (1980), however, wonders whether such a connection, which leads to the future sexualization of relationships, is better or worse than the developmental arrests created by deprivation. He maintains it may appear that the child is seeking the sexual relationship, when it is the longing for closeness that he craves. The emotional cost to the youngster is severe impairment that outweighs any benefits. As stated by Ferenczi (1949), “when love of a different kind from that which they need is forced upon children in the stage of tenderness, it may lead to pathological consequences” (p. 228).

Summit (1983) concurs and views incest as having severe repercussions in youngsters’ development. Based on his clinical experience, he postulates that children forfeit themselves by participating in a sexually abusive relationship through a process he defines as the “Child Sexual Abuse Accommodation Syndrome.” Children also may not make attempts to end the abuse because they are cognizant and fearful of the consequences of disclosure. An alternate explanation for “keeping the secret” is that youngsters often form an identification with their abusers. Any exploration or revival of the memories of the event inevitably point to the perpetrator’s badness. This, in turn, generates concomitant feelings of badness in the victim.

Finkelhor and Browne (1985) developed a model about the impact of sexual abuse, fully asserting that it is not only harmful but devastating. They identify four areas affected by this violation, namely, traumatic sexualization, betrayal, powerlessness, and stigmatization. These categories point to resultant difficulties within the child and the child’s view of others.

Another major contributor to child sexual abuse (CSA) research is Suzanne Sgroi (1982, 1988), whose extensive work with sexually abused victims has repeatedly emphasized the problems manifested by these children resulting from the sexual encounters. She has been preeminent in identifying the behavioral indicators of sexual abuse and the sequential patterns within which this abuse takes place. The question of damage is virtually a moot point for her. Her direct experience in interviewing thousands of youngsters has proven time and again the preponderance of deleterious effects.

Clearly, and as this volume will demonstrate, the effect of sexual abuse is profound; it produces a major alteration to the self. Evidence of this is seen in the ego’s damaged capacity to modulate impulses, utilize defenses, test reality, and moderate superego and id demands. Relationships are often tainted with the ghosts of the event. Consequently, innocent acts of others may be interpreted as attacks on the self. Others become viewed in a distorted manner. All hope of satisfying relationships may be lost. Unquestionably, the power this trauma exerts on the developing personality and character of the child is penetrating.

SYMPTOM FORMATION

Sexual abuse is an act that breaks through the stimulus barrier of the ego, floods the youngster with anxiety, and renders him or her unable to cope. Often the victim is seen diagnostically with symptoms that are characteristic of Post-traumatic Stress Disorder. More alarmingly, victims often exhibit traits of character pathology such as narcissism, paranoia, dysthymia, and borderline, or even psychosis.

Symptoms manifested by these individuals have been widely discussed in professional articles and books. Most writers agree that there are both immediate and chronic symptoms for the majority of sexual abuse victims with general data supporting the hypothesis that emotional disturbances appear to be most severe when the abuse commences at an early age and continues through later stages (Brooks, 1985).

Browne and Finklehor (1986) summarize the immediate aftermath (within two years) as including eating and sleeping disturbances, fears and phobias, depression, guilt, shame, anger, and school problems. They highlight that short-term deleterious effects are mainly of the internal nature such as those reflected in depression rather than in aggression. Peters (1978) notes that there are significant changes in sleeping patterns with a considerable number of nightmares reported. Victims also acknowledge fears of being abandoned and experiencing disturbed eating patterns.

Psychosomatic symptoms also appear to be prevalent among sexually abused victims (Forward & Buck, 1978; Kaufman, Peck, & Tagiuri, 1954). These may include migraines, gastrointestinal disturbances, dizziness, skin disorders, and other debilitating aches and pains. Everstine and Everstine (1989) concur with these conclusions and add alterations in toileting patterns such as enuresis to the list of symptoms. It is as if these victims are more psychologically prepared to deal with the physical pain and discomfort than to face the emotional tensions, anxiety, and conflicts associated with the abuse. They express their distress through their bodies.

Of serious concern is the emergence of a number of psychoticlike symptoms which may appear in various combinations in different children. Among these are hallucinations, delusions, and recurrent and obsessional thoughts, some of which may reach psychotic proportions. Additionally, a breakdown of reality testing and logical thinking ensues (Gelinas, 1983). A state of dissociation, in which the victim consciously induces some type of self-hypnotic anesthesia to avoid the stimuli of the trauma, is also common (Gelinas, 1983).

Cognition is another area impacted upon by the sexual exploitation. One way this type of dysfunction becomes apparent is through school performance. While some sexually abused children seem to excel in this area (Sgroi, 1982) as it is their only haven, others show serious learning problems which may take the form of concentration and attention difficulties (Butler, 1978). It may be that there are intrusive thoughts or overwhelming feelings of anxiety that interfere with the child’s ability to attend to the classwork.

Relational disturbances are frequently noted, particularly in incest victims. Peer interactions are thwarted partly because the preoccupation with sexual impulses has the propensity to isolate the youngster. This preoccupation may result from the physical pleasure invoked by the sexual activity between the adult and child since it often becomes intrinsically reinforcing (Yates, 1982). Ongoing sexual behavior may be the youngster’s way of reenacting some aspect of the trauma to gain control over the associated anxiety. As such, it is difficult to redirect the child away from the sexual activity to more ageappropriate satisfactions. Yates writes that these youngsters are unable to distinguish between sexual and nonsexual relationships. As a result, the role of sexuality in intimate relationships becomes a blurry issue for the sexually abused child.

Finkelhor and Browne (1985), as noted earlier, identify “traumatic sexualization” as one of the four traumagenic reactions to CSA. They describe a child’s sexuality as being developmentally derailed as a result of sexual assault. The youngster gains love and rewards for his or her sexual activity; the child’s sexual organs are given enormous significance and the child, in turn, comes to value them inappropriately. The offender’s communications about sexual mores exacerbate the value of the sexual organs and create a sense of bewilderment in the child about sexual norms. Out of confusion, the youngster may subsequently attempt to engage peers in similar sexual behavior (a form of repetition compulsion), frightening them and causing the others to avoid him or her.

Many authors (Brooks, 1985; Everstine & Everstine, 1989; Katan, 1973; Kaufman, Peck, & Tagiuri, 1954) note that victims of sexual abuse also have a disturbance in the area of sexual identity formation. The victimization skews their sense of sexuality. Their understanding of sexual roles becomes distorted. Some female children tend to identify with the abuser and focus on the acquisition of the penis. The absence of this organ creates a feeling of being damaged. The victim comes to prefer a male identity which is seen as undamaged and powerful. In instances when the attacker of a male is also a male, the victim’s sense of manhood may well be threatened. Experiencing himself as powerless and weak, as well as the recipient of the penis, he may begin to identify with a female role. He may believe that through his passivity he will please the perpetrator and thereby ward off further aggression. Whether the victim and the offender are the same or opposite sex may also effect the victim’s sexual identity. Some studies have linked homosexuality and prostitution to a history of sexual abuse (Ochberg, 1988). This whole area is worthy of more in-depth study.

Self-destructive behavior as a by-product of CSA is noted throughout the literature (Brothers, 1982; Finkelhor & Browne, 1986; Sgroi, 1982; Shapiro, 1987). Often the victim’s need for self-punishment, as a response to feeling guilty and bad, leads to such behaviors. At other times, pain is self-induced to counter the feelings of numbness and deadness. Some victims masturbate compulsively and excessively, often to the point of self-injury. Incest victims are frequently filled with suicidal ideation and may attempt suicide. Delinquent behaviors, and those carried to a more extreme level, as identified in the DSM-III-R under Conduct Disorders, have also been identified as part of the consequences of the abuse.

Development of a Borderline Core

Children who have been sexually abused by trusted caretakers, upon whom they are dependent, find their basic concept of self and the world severely shaken. The youngster’s character structure, self-image, self-esteem, and trust in self and others take on new and different forms. In a sense, the child who existed prior to the trauma has been murdered; a new child emerges who may be jaded and damaged. Shapiro (1987) suggests a relationship between incest and the borderline personality organization. The Everstines (1989) also point out that childhood sexual trauma can be linked to Borderline Personality Disorder. The rudiments of the main characteristics of the Borderline Personality Disorder, namely, poor impulse control, high anxiety, acting-out behaviors, splitting, intensification of aggression, and sublimation difficulties, are often manifested in the symptom picture of the sexually abused child. Impulse control problems are frequently introjected from parental perpetrators who, by the very act of sexual exploitation, model acting out. In addition, the aggressive and libidinal drives to which the perpetrator yields are also stimulated in the child, negating the possibility that the youngster can sublimate them.

As a result of sexual victimization, particularly molestation that is ongoing, the youngster’s ego becomes flooded with anxiety and his or her impulse control becomes increasingly tenuous. Generally, part of the function of an introject is to support such controls and to provide self-soothing functions. In order to maintain a positive internalized image of the exploiter and/or the nonoffending parent, the child begins to separate or split apart positive and negative attributes. This functions to ward off more widespread anxiety and to preserve the integrity of the ego, upon whose foundation are built positive introjects and internalizations. The splitting safeguards the youngster’s ego by separating out the parts of the introjected parent that represent the conflict created by the sexual abuse.

Mood Disturbances

An important, if not essential, area of human experience acutely affected by sexual abuse is the arena of emotions. This is where we experience the fullness and breadth of our humanness. For the sexually abused child, the world of feelings often becomes constricted and diminished. Although clinicians have historically felt that childhood depression is a rare situation, within the last 25 years it has been acknowledged.

Symonds (1966) believes that depressive states in children are expressed through their behavior. Sad youngsters do not act sad; they act bad. Psonanski and Srull (1970, cited in Chess & Hassibi, 1981) identify the following criteria for childhood depression: feeling sad and unhappy with episodic crying; apathy; withdrawal; disturbed sleep; feeling rejected and unloved; low self-esteem; negative self-image; and self-destructive ideation.

Depression, frequently chronic, is the single most common response to childhood incest (Browne & Finkelhor, 1986). Sexually misused children exhibit a typical depressive symptom picture. They are filled with somatic concerns including hypochondria, headaches, and stomachaches. Helplessness is also a very immediate experience for them. The abused child becomes overpowered by the adult and is left feeling fearful and anxious. Due to the youngster’s inability to stop the molestation, an impaired sense of efficacy develops, which is often “associated with … despair, depression, and even suicidal behavior” (Finkelhor & Brown, 1985, p. 536). Guilt is a common reaction to the abuse, feeding back into feelings of depression and loathsomeness.

Another major consequence of the sexual exploitation is the child’s limited ability to experience a full range of emotions. In attempting to close the door on the intolerable feelings elicited from the abuse, the child inadvertently blocks an avenue that allows entry of positive feelings. More alarmingly, the youngster experiences a deadness, a total emotional void. Krystal (1988) writes about “alexithymia,” an inability to differentiate affects, psychological numbness, or general affective disturbance. He states that trauma causes a regression in the ability to express emotions.

Freud (1926/1953) remarks that the actual danger in a situation is unimportant in relation to this syndrome, for it is the victim’s subjective evaluation of the peril that determines the psychological sequelae. Sexually abused youngsters often fear for their lives despite the presence or absence of actual threats. When youngsters feel helpless, they give up. Their emotions, which at that point, are too painful and overwhelming, propel them to repress their feelings and thereby relinquish part of their selves. Their anxiety and excitation change to surrender and passivity; they experience either no feelings or, at the most, vague, diffuse, and undefined emotional sensations.

The consequences of this go beyond the obvious. We use our emotions to help monitor or evaluate ourselves, to provide signals to generate specific behaviors and to set a path of direction for actions. Alexithymics are unable to differentiate between such emotions as happiness, sadness, hunger, or exhaustion and, instead, have a general sense of discomfort which they are unable to specify. Their affects are often expressed somatically and are manifested through an array of physical problems.

RUPTURED TRUST

As mentioned previously, one of the most profound and universal impacts of sexual abuse is the disintegration of the children’s sense of trust in themselves and in the adults upon whom they depend. The American Heritage Dictionary of the English Language (1981) defines trust as “firm reliance on the integrity, ability or character of a person or thing; confident belief; faith” (p. 1378). Erikson (1963) believes that a state of trust implies “that one has learned to rely on the sameness and continuity of the outer providers … [and] also that one may trust oneself and the capacity of one’s own organs to cope with urges” (p. 248). Trust both in the environment and in oneself develop simultaneously throughout the life cycle, changing and modifying as a result of one’s experiences. Brothers (1982) delineates the aspects of each of these areas. The development of the ability to trust others includes experiencing others as decent, helpful, unselfish, compassionate, shielding, dependable, and responsible and nonabusive of another’s deficits. Varying levels of trust develop in children based on their individual experiences. A sense of trust is an evolving process influenced by life events (Erikson, 1963).

Trust in Others

Brothers (1982) has found that while the effect on the child’s trust of others may be either heightened or diminished as a result of sexual exploitation, very frequently there is inflated trust in others. She explains that this paradoxical reaction may represent the victim’s attempt to protect the trusted perpetrator in order to maintain his or her own ability to trust the outside world upon which the victim is vitally dependent. Acknowledging the malevolence of the perpetrator would otherwise cause the child to withdraw from others at a time when they are most needed. The need to hold others in high regard and also continue intimate relationships is so strong that the victim will often sacrifice his or her own integrity to do so.

Incest, in particular, occurs within a relationship that is supposed to be based on care, protection, and nurturance for the youngster. It is a place where the child should be able to receive an understanding of reality and relationships. In fact, “incest is a profound abandonment and betrayal, a travesty of the parental love and care that is a young child’s inherent right” (Gelinas, 1983, p. 319).

Trust exists along a continuum within which a paranoid disorder can be seen as representing the most extreme rupture. Its hallmarks are extreme suspici...

Table of contents

• Front Cover
• Title Page
• Copyright
• CONTENTS
• List of Drawings
• Acknowledgments
• Introduction
• A Cry from the Abused
• 1.Paradigms of Trauma and Sexual Abuse
• 2.General Principles in the Analysis of Projective Drawings
• 3.The Projections of Ego Functions of Sexually Abused Children
• 4.Aberrations in the Superego of Sexually Molested Youngsters
• 5.The Incestuous Family’s Influence on the Development of Object Relations During Latency
• 6.Adult Survivors: The Long-Term Effects of Childhood Sexual Abuse
• A Survivor’s Letter; “An Open Letter to My Children”
• Bibliography
• Index