Emerging from Childhood Sexual Abuse
In North America between 15% and 25% of women and between 5% and 15% of men have been sexually abused as children. When compared with depression (affecting around 17% of American adults in a given year) and anxiety (around 18%), childhood sexual abuse appears among the most common obstacles to mental health. Yet where disclosure of depression or anxiety will generally receive a sympathetic response, disclosure of sexual abuse may meet with a stunned silence or even ostracism. And while those suffering from depression or anxiety are seldom held responsible for their condition, victims of sexual assault may be considered somehow complicit in the abuse.
It has been estimated that more than 70% of abusers are immediate family members or someone very close to the family, leading one psychotherapist to describe incest as the “perfect crime,” seldom reported and seldom punished. One major obstacle to dealing with childhood sexual abuse is the nature of memory. In contrast to other traumatic experiences, which can often be recalled as normal, narrative memories, recollections of sexual abuse tend to be fragmentary and disconnected, in some cases involving full or partial amnesia, so that the victim, when contrasting these memories with normal memories, may entertain doubts that the abuse actually occurred. In the case of full amnesia, the body experiences symptoms while the mind has no conscious memory of abuse even happening. The makes it extremely difficult for victims to heal unless they experiment with techniques that help recover their memories. Clients frequently report suspecting that they may have been sexually abused without having any concrete memories. Add to this the responses abuse victims frequently encounter—“Don’t tell anyone, it would harm the family” or “Don’t tell, it would kill your mother,” or worse “That could never have happened—you’re just imagining it”—and it can hardly be surprising that much sexual abuse goes unreported. I have often had clients tell me, “This is the first time I have told anyone about these experiences.”
One prominent psychologist distinguishes three phases of repeated childhood sexual abuse. The “before” phase typically includes fateful words that the victim associates with the abuse to come. “I’m going shopping now,” for example, may signal the absence of the mother during which the father regularly carries out the routine of abuse. This phase may produce as much inner turmoil as the abuse itself since the victim knows him/herself to be incapable of preventing it. The “during” phase often includes dissociation in which the victim effectively “tunes out” or “leaves his/her body.” As a result, victims of childhood abuse may retain vivid memories of, for example, the details of the ceiling molding while summoning only sketchy memories of the abuse itself. The “after” phase may be the worst of all, as the child comes to interpret the absence of consequences as adult approval of the abuse. Where other childhood trauma, be it a sprained ankle or a scraped knee, inevitably brings soothing words and healing treatment, sexual abuse often leaves the victim in a state of bewildered solitude.
Childhood sexual abuse leads to the kinds of symptoms associated with other forms of post-traumatic stress disorder, including flashbacks, nightmares, sleep disorders, hypervigilance, exaggerated startle reflex and emotional numbness. The consequences of sexual abuse, however, do not stop here. The loss of self-esteem suffered by abuse victims often includes seeing him/herself only an object for the pleasure of others, with no other worth. Abuse may include long-term physical effects such as distorted posture, as the body instinctively tries to protect itself; problems with digestion or elimination; even problems with breathing, associated with a fear of a deep, relaxed breath.
Sexual abuse has a contaminating effect on normal sexual development. Our personal understanding of sexuality is deeply influenced by our initial sexual experience. Having that experience associated with pain, fear, and powerlessness has a profound negative effect on one’s adult sexuality. Similarly, linking sexuality with dissociation may prevent sexual pleasure. Victims of sexual abuse typically display the extreme responses of either sexual aversion and/or numbness on the one hand, or sexual compulsion or promiscuity on the other.
Recovering from sexual abuse through processing negative memories, for example through EMDR (Eye Movement Desensitization and Reprocessing), usually takes much longer than recovery from other traumatic experiences. Clients often find that their brains release details of the abuse experience very gradually. First comes the unwelcome consciousness that abuse has occurred, often with the assumption that it was confined to a single incident, mostly lacking in details. Little by little details of the experience may emerge, along with a realization that the abuse occurred repeatedly. Generally, each of these memories must be processed in turn, leading to comparison with the multi-headed hydra of mythology that grew two new heads for each head cut off.
The very title of the classic book by Ellen Bass and Laura Davis, The Courage to Heal (4th edition, 2008), contains much wisdom. Victims of sexual abuse must deal with feelings of shame and guilt in addition to all the other ramifications of trauma. They must face the general non-acceptance of their distress as a topic of conversation, an experience that only compounds their sense of aloneness. They need to be willing to embark on an extended journey of healing.
How can one promote healing from childhood sexual abuse? Perhaps the first and most important step is to emerge from a state of shame-filled solitude. Reading the stories contained in The Courage to Heal and comparing them with one’s own experience can help to “normalize” the abuse, as can joining a recovery support group. Telling one’s story to an accepting audience can help to reverse the effects of denial and repression by oneself and one’s parents. The guidance of an effective therapist can also foster the healing process. Victims of sexual abuse frequently, and unconsciously, choose abusers to be their adult sexual partners. Finding a trustworthy, caring life partner can be an important step on the road to recovery.
Victims of childhood sexual abuse, as they undertake the process of healing, may want nothing to do with sex, and often a “sex holiday” (meaning a holiday from sex, not a holiday for sex) may provide an essential “safe place” for healing to occur. Supportive, understanding partners can help abuse victims to overcome a long-held belief that their only worth lies in their sexuality. There is always the danger that feelings toward the abuser may be transferred to the partner. Putting sex on the “back burner,” so to speak, may be necessary to allow full concentration on healing.
When the time comes to reclaim sexual activity, it is usually necessary to take steps to “decontaminate” sex from sexual abuse. Certain aspects of foreplay, for example, may be so closely associated with elements of abuse as to render them turn-offs instead of preludes to a rewarding sexual experience. There may be certain places where a victim of childhood sexual abuse cannot stand to be touched.
One way to overcome the contaminating effects of sexual abuse is to come at sex from a different angle. Instead of directly resuming sexual activity, it may be helpful to approach sex through sensuality. Incense, soft music, and candles, for example, may enhance sensory stimulation in a manner completely separate from sexual activity. The Art of Sensual Massage by Gordon Ingeles (Arcata Arts, 2011) offers detailed instructions for massaging different parts of the body. Scented oils and creams help to enhance the sensory experience. Massaging the feet, for example, can promote the construction of new neural pathways linking touching to pleasure without invoking previous associations of physicality with pain. Moreover, the very act of talking over different forms of massage, discovering what each partner considers might be pleasurable, promotes partnership intimacy.
The idea of a “sex holiday” should not be equated with indifference and separateness. On the contrary, the temporary exclusion of sexual intercourse can be embraced as a stimulus for alternative forms of physical intimacy. Marriage manuals generally include the recommendation for “four hugs a day.” This may seem mundane until you acknowledge that you may not be embracing your partner as much as you once did. Do you walk hand in hand, or do you put your arm around your partner’s shoulders or waist? Do you have some non-verbal ritual for reaffirming your abiding affection for each other every time you part (either physically, in leaving for work, or virtually, in dropping off to sleep) or reunite (returning from work, awaking in the morning)? Can you summon occasions for looking deep into each other’s eyes? Can you make a point each day of expressing your appreciation of your partner in some specific detail?
If you are the victim of childhood sexual abuse, you need to find someone who can listen completely and non-judgmentally to your thoughts and feelings. You need someone to reinforce your developing sense of self-esteem, to encourage getting in touch with your feelings, to help eventually reclaim your sexuality. If you are the partner of a victim of childhood sexual abuse, you can be of invaluable assistance in each of these areas.
The book Self-Esteem (Matthew McKay and Patrick Fanning, 3rd edition, 2000), which many of my clients have found helpful for a variety of issues, can help promote the healing process, enabling former victims of childhood sexual abuse to proclaim “Victim no more!”
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