|LUCID PAGES||INCEST AND SEXUAL ABUSE|
Healing from CSA
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ACTS OF SEXUAL ABUSE
All forms of sexual abuse, including exposure to sexual talk, pornography, or masturbation, may affect the victims for life. Rape of women and also men is a very traumatic experience, often leading to severe mental problems, addictions, phobias, and nonspecific worries. The victims may suffer physical damage, psychological damage, and neural damage as a consequence of a single sexual attack. Assaults that result in vaginal, anal, or oral penetration, or in genital mutilation are the most traumatic. The victims have to deal not only with the realization that they can become totally helpless, but also have to learn to live with the experienced disgust and the perceived shame of the abuse. All these problems are much worse when the victims are children, and even worse when the children are repeatedly raped by close family members for many years.
WHAT IS SEXUAL ABUSE?
Sexual abuse consists of some acts that would be considered abusive in all cultures. This usually includes all forms of sexual penetration and all acts that are done for the purpose of pleasing the perpetrator. Some forms of sexual interactions might be acceptable in some cultures, and abusive in others. For example, some African natives breastfeed their children until age 15. Although this behavior is sexually abusive to the child, the act has become part of social culture and is considered normal. The abusive nature of the activity may not be consciously apparent to the child, but causes unconscious problems and abnormal mental development. Also western cultures have legalized and socially embraced certain forms of sexual abuse. Until recently, Great Britain did not recognize oral rape as a form of sexual abuse. As for child circumcision, it is currently practiced by most industrialized countries. The medical industry even promotes this surgical procedure and praises it for having "beneficial effects" on the child's health. In essence, such forms of sexual abuse are institutionalized psychopathology, and the children are always affected mentally.
In addition to acceptable but abusive behaviors, there are interactions that are in the gray zone. For example, breastfeeding a child up to 1 year of age seems necessary, but breastfeeding the child up to the age of 3 years might be considered abusive. In this case, it should be determined whether or not the breastfeeding is necessary to properly nourish the child. If not, then it is time to stop. A similar issue is bathing of naked children and washing of their private parts. Is it necessary to touch the child's anus with a bare hand? Is it really necessary to pull back the boy's prepuce or to spread the girl's labia minora? Is it really necessary to wash and touch the child's genitals that often? Is it done for the benefit of the child or for the sexual curiosity of the parent? These activities are part of legitimate child care, but can quickly deteriorate to abuse. An example is first menstruation of girls. Some parents are overly inquisitive and create a psychologically damaging environment. An adolescent girl may feel that there is something wrong with her or that she is damaged once she has had her menarche. Another common form of abuse, even among adults, is kissing. People meet on some occasion, and the guys want to kiss the pretty girl or woman. And older women often encourage the acts as socially proper. The same abusive behavior involves hugging. An adolescent girl with prominently developed breasts is eagerly hugged and pressed against the chest of a male relative or family friend. The social environment creates conditions for socially acceptable forms of sexual abuse, and abusers happily exploit the opportunity. In general, abusive is anything that is not essential for the child's health or hygiene, or what is done against the wishes of the child. And silence or obedience does not mean that she is a willing participant.
THE UNIVERSAL EFFECTS
Sexual abuse of a child can lead to dissociation and neuropsychological damage. These two effects are universally present whenever undesirable sexual penetration occurs. As a consequence, the child loses some amount of his or her emotional intelligence. If the abuse is repetitive, as it is in the case of intrafamilial sexual abuse (incest), the dissociation becomes severe and leads to lasting and irreversible brain damage that spreads beyond the neural substrates of emotional intelligence. The dissociated victims are then guided in life by their formative experiences and malfunctioning brains. Some of the unusual behavioral manifestations of the victims have been associated with sexual abuse by practicing medical doctors and psychotherapists. Highly qualified experts with clinical knowledge often equal such manifestations to proof that severe sexual abuse has occurred. By contrast, the public, judges, juries, and lawmakers (who often have diminished emotional intelligence because of childhood sexual abuse) are usually incapable of noticing and acknowledging such behavioral traits, or associating them with any degree of confidence with childhood abuse.
From the practical viewpoint, acknowledgment or denial of child abuse by the society has no major effect on the health of the violated child. Her damage is lasting and has impact on all areas of her existence, including the ability to reason, learn, play, enjoy life, have wishes, develop good aesthetic sense, form friendships, being honest with herself and with others, and exercising sound judgment. The abused child is usually unable to understand the relationship between cause and effect within the domain of emotional intelligence. Since rapists are former victims of child sexual abuse, this trait can be seen in the whole abusive family. Strange notions such as these can emerge:
TYPES OF SEXUAL ABUSE
Milder forms of sexual abuse usually do not involve physical contact, but do restrict the victim in her movement either by physical or mental means. She may be locked up in the same room with the abuser or she may be told to sit in a specific place. The containment robs the child victim of free will and comfort. The perpetrator may stay beyond the reach of her hands, but he is too close to disturb the child's near extrapersonal boundaries. If he approaches the child within the reach of her hands, he also penetrates her peripersonal boundaries. He need not be touching the child, but she feels uncomfortable and dominated by the proximity of the perpetrator. Her mental boundaries are being violated.
The victim of such non-contact abuse is mainly dissociating only during the unpleasant encounter. After the abuse, the child appears almost normal. But repeated exposures of this kind may lead to more serious dissociative modes and a permanent state of being dissociated. One of the dissociative modes is peritraumatic dampening of emotional intelligence. This cognitive deficit normally leads to incorrect storage of memories of the abuse. A more serious consequence is the development of multiple personality disorder. The degree of multiplicity is rather mild in this case in comparison with the degree of dissociation caused by sexual abuse that involves physical contact.
Physical contact is the next level of abuse on the severity scale. During this form of abuse, the perpetrator directly acts on the victim's body. Violation of the skin through exposure to undesirable objects, substances, and sensations breaches another mental boundary of the child. The nature of the abuse often demands restriction of the victim's movement. She is cornered or physically held against her will, or is forced to endure the undesirable body contact because of her psychological subordination to the perpetrator. She may depend on him or he is in a social position of power. The physical acts include caressing with hands and lips; embrace of the torso; fondling of the neck, hips, thighs, breasts, genitals, or anus; or forceful groping of the victims' body parts. These victims tend to develop more severe consequences than victims of non-contact abuse do. Even one incident of this nature may leave the victim with a vulnerable feeling for the rest of her life. She is likely to have nightmares about the incident and may be unwilling to kiss or touch those whom she loves. Repetitive abuse of this sort can produce medium level of multiple personality disorder. The personalities are fully developed but are few and do not interfere with the victim's daily life.
The next level of sexual abuse is exposure to the perpetrator's private parts, genitals, and their excretions. Here belongs attempted rape, ejaculation on the victim's body and face; stroking of the victim with the perpetrator's penis, vagina, or buttocks; forcing the victim to kiss or lick the abuser's genitals; and simulated intercourse, with the penis rubbing against the skin while being wedged between the victim's thighs and vulva, or between the thighs and the anus. Depending on the intensity and frequency of these episodes, the victim may develop medium to severe level of multiple personality, and possibly mild degree of complex dissociative disorders.
Physical penetration of the victim's body is the next level of abuse. All variations of this abuse are severe. Milder forms include penetration with inanimate objects, such as pens, carrots, or dildoes, and introduction of substances into the body in the form of lubricants, irritants, or edemas. Also French kissing, when the tongue penetrates into the mouth of the victim, belongs to this level of abuse.
More severe violation of somatic boundaries involves penetration of the victim with unpleasant objects and substance. The perpetrator may force the victim to lick or to swallow the abuser's ejaculate or vaginal discharge. The abuser may insert just the tip of his penis into the vagina without penetrating beyond the hymen. Or he may insert only the tip of his glans into the child's anus without penetrating beyond the sphincter muscle. The intensity, frequency, and subjectively perceived disgust of these abusive acts determine whether the victim will develop just multiple personality or complex dissociative disorders.
Even more severe forms of physical penetration are associated with oral, vaginal, or anal rape, when the abuser penetrates deep into the victim's body with his penis. The depth of penetration matters because it violates an additional layer of the victim's personal boundaries. The assault is perceived as a breach of the protective surface layer and penetration into the core of the human organism. Also important is the difference between a penetration by the penis or a finger versus an inanimate object. The victim perceives inanimate objects less harmful and less disgusting. But there are exceptions to this rule. A knife or razor blade inserted into the vagina or anus of the victim is perceived as incomparably more frightening than penile penetration. The victim is scarred, frantic, and helpless, and may faint. By contrast, a victim who is forced to swallow the abuser's urine or excrement may feel less fear, but experiences indescribable disgust. In either case, the victim may develop severe degree of multiple personality and a substantial level of complex dissociative disorders.
The worst form of abuse is sexual penetration of the victim's body in combination with somatic harm or mutilation. Harm to the body breaches yet another level of the victim's psychosomatic boundaries, which leads to more severe neuropsychological impact. The forms of such abuse typically involve forceful penetration and unintentional damage of the vagina or anus. Although hymenal laceration is the first thing that comes to mind, a torn hymen is a minor injury. Much more serious is a vaginal tear, when the perineum, separating the vagina from the anus, becomes torn. This outcome typically happens when the difference between the penis and the vagina is too big. An example is a rape of a girl under the age of 6 years. Similar tear may occur in the anus, and even at an older age. In addition, involuntary contraction of vaginal and anal muscles may prevent easy penetration of older victims. Under these conditions. the victims suffer serious tears if they are penetrated by brute force. The damage often requires medical attention.
A second form of this type of abuse is willful mutilation of the victim's body. This may include physical torture; shocks with high voltage generators; lacerations; piercings; skin burns; tearing off of nails; pulling out the victim's teeth; burning of genitals; breaking of bones, injections with substances, exposure to cold or heat, circumcision, cutting off of the victim's limbs, breasts, vagina, penis, or testicles. Forceful insertion of large objects into the victim's vagina or anus, or insertion and detonation of explosives in the vagina, anus, or mouth. The forms of human perversion are endless and come to light in rare cases. Such acts are more often encountered in war zones and in concentration camps, where victims have no way of seeking help and protection.
Additional comparable forms of abuse that do not cause permanent somatic harm and are mainly psychological can involve the following: burying the victim alive, gang rape, forced prostitution, mocked execution, and waterboarding. In all of these cases, the abuse is inflicted on the mental core of the person.
The consequences of cruel sexual abuse and somatic damage are often life-threatening. A victim of such abuse is likely to develop a severe degree of multiple personality and complex dissociative disorders, including hysteria, bipolar disorder, and borderline personality disorder within a relatively short time. She may attempt or commit suicide. If she survives, she often develops additional psychosomatic or neurodegenerative illnesses in adulthood.
DURATION OF ABUSE
There is a strong body of evidence indicating that children before the age of 3 years are the most vulnerable to be abused and the least able to disclose their abuse to others. Such children may have venereal diseases in their throats because of oral penetration. Or the children may have venereal diseases at their genitals because of genital rubbing by the abuser's penis or vulva. The children may suffer from various allergies and may be highly susceptible to common illnesses because their immune system is weakened by the abusive experiences. In response to the traumas, some children may develop psychosomatic illnesses and die before they reach school age. Others may survive, but are left with permanent damage to their affect, reason, or sensory abilities.
Children between 3 and 7 years are still small to be used for sexual intercourse without risking severe harm to the anus or vagina. It is likely that these victims are abused by oral intercourse and simulated genital intercourse, with the perpetrator's penis staying outside the body. Although these scenarios are generally true, some perpetrators rape even little children. The somatic damage is typically extensive and must be treated by a doctor. Surprisingly, doctors are particularly prone to rape their daughters or sons at this age, and then sew them up to cover up the crimes. It all stays in the family. But age itself is not the only factor in having a vaginal tear after a rape. Even adults can have serious vaginal tears when they are raped, and particularly gang-raped. The following data show that there is no safe age for no vaginal tears or life-threatening bleeding.
A rape victim who is a virgin may long to have her torn hymen restored to normal shape. This may be a matter of survival in Third-World countries where virginity is required to get married or to stay alive. But also in industrialized countries, raped girls wish to have their "virginity" restored. Such a wish usually reflects a serious psychological problem. Repair of the hymen is not necessary to be physically healthy and happy. The desire is only driven by psychological needs. Restoration of the hymen does not even assist in mental healing from rape. A mother of five who is raped will suffer a similar mental trauma as a 12-year-old virgin does. Both victims will experience the same kind of feelings and mental problems. The only difference is that the mother will not have an urge to have her hymen restored. She has had sex many a time; the remnants of her hymen have almost disappeared, and physical interaction between sexual organs is known to her very well. But the mental aspects of rape cause her so much post-traumatic pain. Thus, restoration of the hymen only satisfies the victim's longing to turn back the time and undo what has happened. The wish manifests dissociation and magical thinking. These traits may have been caused by earlier sexual abuse, which the rape victim may have forgotten.
According to statistical research, both boys and girls are most vulnerable to abuse between the ages of 7 and 13 (Finkelhor, 1994) . These are the years when vaginal or anal rape is most likely to occur. Too young children would usually suffer serious bodily harm if penetrated, and the abuse would become apparent. Older children are too old to be abused reliably and are a liability for the perpetrator. He may stop his abuse because he worries that a girl might become pregnant, or the child is simply too mature or physically strong to be subdued and raped without the risk of public exposure and legal problems. This is why the time between 7 and 13 years is the "Golden Age."
At some point in the child's life, the abuse stops. This depends on many factors. Some fathers carefully watch the physiology of their girls and do not touch them after the first menstruation, which typically happens between 12 and 13 years. However, the Author's clinical experience suggests that a significant number of 14- and 15-year-old girls are still used for sex by their fathers. Particularly religious patriarchs are extremely unwilling to stop having sex with their children. Intercourse with such children may only stop at 16, 17, or 18 years of age, and in rare cases may continue beyond the age of 20 years . Some reports indicate 18-year-long sexual abuse , presumably from the first memories at 3 years up to 21 years. In extreme cases, fathers hold their daughters as sex slaves well into their adulthood. Elisabeth Fritzl of Austria was imprisoned by her father at 18 and was kept for 24 years . Lydia Gouardo of France was imprisoned by her father at 8 and was kept for 28 years . A man from Torino, Italy imprisoned his daughter Laura and kept her as a sex slave for 25 years . Some fathers imprison their whole families. Patrick McMullen from Salem, MA, USA imprisoned his family for years, beat his wife, and raped his daughters . An abuser who has no child of his own finds himself one. A man abducted the 14-year-old Elizabeth Smart of Utah, USA from her home and kept her as a second wife for 9 months, until she was identified by police . Natascha Kampusch of Austria was kidnapped and held as a sex slave from age 10 to age 18, when she escaped . Jaycee Lee Dugard of California, USA was kidnapped at 11 and was kept by her abductor as a second wife for 18 years, until she was accidentally discovered by a parole officer . Interestingly, both Elizabeth Smart and Jaycee Lee Dugard had plenty of opportunities to escape their kidnappers. But the girls did not exploit the opportunities and were hiding their identities even when stopped and questioned by authorities. Additional cases of intrafamilial rape follow:
Next to the classical form of child sexual abuse perpetrated by a parent or close relative, there is also reverse abuse. This means that children sexually abuse their parents or other elders. The known cases are a tiny percentage of all rapes of this type. Most assaults go unreported. The reason is an incredible degree of shame the victims associate with their rapes in general, and with their relationships to the rapists in particular. The victims often have a strong emotional bond with their rapists and are unwilling to come forward for fear that the attackers would be punished. Incidentally, only a few mothers disclose that they were raped by their sons. Rather than seeking help, the women keep silent or may take their lives. Likewise, not many teachers will admit that they were raped by their students. The social and professional stigma is enormous.
WOMEN AS SEXUAL ABUSERS
The presented data may give the impression that males abuse females, and sometimes other males. Girls and women always appear as victims of attacking males who want to sexually, physically, and psychologically dominate over the gentle sex. But this impression is not entirely correct. Statistical studies of the Author reveal that girls and boys are just as likely to be raped and otherwise sexually abused by a significant male in their lives. The male attacker seems to express his sex drive from the position of conquest, dominance, and doing things to the helpless sex partner (holding, squeezing, positioning, penetrating, and ejaculating). A closer examination of the male character reveals that both consensual sexual intercourse and unwanted sexual assault are driven by the male's desire to reach a satisfaction. The satisfaction is physical in the form of ejaculation and cancellation of the urge to copulate; emotional in the form of feeling good; and mental in the form of accomplishing a goal. The psychological reason for the male's desire to have sex may not make much difference to the victim, but the motivation is important to recognize if we want to understand sexually abusive women.
In general, the female mind works differently than the mind of a male does, and the reasons for female behaviors are often very different than the reasons for male behaviors are. The motivations are even more different in the case of sex. A typical male delivers the sexual activity and stimulation, while a typical female receives what is done to her. The male acts on his sex drive by expressing it, and the female by experiencing his expression. During consensual intercourse, the partners interact. The male physically reacts to the passive and active stimuli he receives from the female partner. His sensory experiences of her attractive physical attributes and of her wishes expressed through voice, body language, or actual behavior guide him to deliver the appropriate acts and stimuli. A rewarding experience in a male is achieved easily by stimulating the senses and the body, but the experience of a female has a broader meaning.
As in a male, having a rewarding experience of sexual activity is the driving force behind the female motivation to have sex. Unlike the expressive male, a female has a strong need to receive and perceive stimulation to satisfy her physical, emotional, and mental needs. This difference shows in her attitude when she is in love. She must have all types of her needs fulfilled to feel loved. By contrast, a male feels in love simply because he finds his female partner sexually attractive and is accepted by her. And when he starts having regular sexual intercourse with her, he is certain that this is what love means. But her concept of love is worlds apart. She not only needs to receive stimulation; she also has a strong desire to be needed and to care for her partner. Caring for others, doing nice things for them, and above all be needed is the expression of the female sex drive. This form of expression does not involve sex, but is general in its scope. And from these two positions of receiving stimulation and doing things for others, women approach sexual abuse of children and adults.
Both abusive men and women seek satisfaction, but each has a different concept of what satisfaction means. Furthermore, sexual abuse damages the brain and may produce behavioral motivations that are typical of the opposite gender. Multiple personality enhances this effect and may create both male and female personalities in the same person. Similarly, traumatized personalities who were abused in specific ways may recreate these abusive acts even though they are not representative of the female idea of sexual satisfaction. This is why some abusive women may exhibit traits that are usually found in males.
Nowadays it is clear that some women do abuse children sexually. How many women do it is hard to tell. Various studies estimate that up to 20% of women could be sexually abusing children. But is the number real? The difficulties in producing any meaningful statistics are given by the increased secrecy when women abuse children and by the different forms of abuse females resort to. Unlike men, who simplemindedly crave to achieve sexual penetration by the penis, women choose variety of behaviors that meet the sexual needs of women. When abuse by a male is detected, it is so usually because of his penile involvement. He may tear the victim's hymen or anus, or may make her pregnant. Female perpetrators normally do not produce these symptoms. Also the likelihood of giving a child an STD is lower in females. The simple reason is that they are less promiscuous than men are.
When females abuse children, they are likely to do so in the context of loving, teaching, rewarding, nurturing, or caring. The physical aspects of the abuse are different, too. To sexually penetrate their victims, women may use edemas, small objects, or their fingers. The likelihood of physical damage to the child's anus or vagina is considerably reduced relative to penile penetration. Unlike most men, women may masturbate a boy's penis, stimulate the physiological responses of a girl's body, or force children to interact with the women's bodies in sexually pleasing ways. A teenage boy who is induced to have intercourse with a woman may feel that she is letting him onto her territory, that he is accepted, privileged, and that she is doing him a favor by allowing him to satisfy his sexual curiosity. He may believe that she has helped him become a man by teaching him about the secrets and wonders of sex. He may not see his experience as abusive; he may have no idea what the sexual relationship will do to him in the long run. Yes, women often develop relationships with their victims. Men predominantly want sex, but abusive women express their sexual perversion in ways that affect many areas of the victim's existence. Recognizing these patterns as abusive is difficult even for professionals. In cases of father-daughter relationships, the term emotional incest has been coined during the last 30 years and has been considered a rare occurrence relative to the usual sexual side of abuse. However, this form of incest is typical of abusive females, and the mental consequences for the victim can be just as severe as those produced by abusive males are.
PREVALENCE OF CHILDHOOD SEXUAL ABUSE
Prevalence of child sexual abuse is a matter of hot debates among experts. All research methods applied thus far have had some serious flaws and have not allowed straightforward determination of the prevalence of sexual abuse. Only few victims of sexual abuse in childhood become pregnant and deliver children, and thus provide indisputable forensic evidence. The overwhelming majority of cases are discovered from self-reporting, usually many years after the abuse stops. Self-reporting faces many problems. Some are methodological. For example, unsolicited telephone calls will produce many rejections to participate. Similarly, unsolicited mailings of questionnaires will be associated with many rejections. The reasons can include lack of time, no interest in the project, unwillingness to work for others for free, or unwillingness to discuss sexual issues. Those who do reply may not provide correct answers. Again, the reasons are numerous.
Some of the methodological problems can be overcome by interviewing hospitalized patients, but even these subjects may not be willing to discuss sexual abuse. Some societies have strict taboos against any talk about sexuality, and studies of abuse will not produce meaningful results. Other societies and social groups have been raised with the mentality to preserve family secrets. Also members of these families will produce poor statistics. For example, if members of the U.S. Congress were questioned about their childhood sexual abuse, the reported prevalence would be exceptionally low. If the same study were conducted with people living on the street, the reported prevalence would be much higher. Even when the subjects are willing to truthfully answer all questions, the subjects may fail to remember their childhood abuse. Dissociation from abuse is a serious problem and can never be excluded when statistical studies are based just on interviews. To obtain meaningful statistics, health experts need to employ objective qualifiers of childhood abuse. There are symptoms and aftereffects that persist even years after the abuse stops. Some of them are discussed below. But even these qualifiers are not without flaws. Many qualifiers are not recognized or are not believed to be qualifiers by most health experts. Some qualifiers are so abundant that they produce unbelievably high prevalence of childhood sexual abuse. The qualifiers are ignored because the researchers are shocked by the high incidence and refuse to believe it. Some qualifiers are found in the researchers, in their significant others, or in people who are in the positions of power or social prestige. Also these cases are often rejected as unbelievable because they challenge the researchers' beliefs about the world. The unbelievable transforms any objective study into a subjective one and produces skewed results.
Obtaining meaningful data about the prevalence of sexual abuse, and specifically about the prevalence of involuntary father-daughter and father-son sexual intercourse, is extremely difficult. Most researchers have used anonymous questionnaires, and the response rates were often below 60%. Those who responded might have deliberately entered false answers or might have not remembered their abuse because of dissociation. No one can tell for sure. Another problem with such studies has been poor definition of sexual abuse. Some researchers define it as any unpleasant experience of sexual nature. This may include sexual remarks, teasing, or occasional touching of the buttocks or breasts. At the other end of the scale lies sexual penetration with force or under threat, and even torture and mutilation. Because of these inconsistencies, the data have large spreads.
Researchers have found significant association between childhood sexual abuse and teen pregnancy , and RAINN reports that 14.8% of American women have been raped in their lifetime . Finkelhor's data (based on 13 studies in the USA between 1975 and 1985) reveal that the incidence of sexual abuse was from 6% to 62% for females; and from 3% to 31% for males . The numbers include abuse by people within and outside the family. However, most researchers find that between 80 and 90% of all sexual abuse happens by known people, such as family members or various acquaintances. The traditional form of sexual intercourse between father and daughter has been estimated to involve only 1% of American women . In rough agreement with this number, one study found that 11% of all rape victims are abused by their fathers or step-fathers . Unfortunately, the official findings are too good to be true. Many experts believe that intrafamilial sexual abuse is grossly underreported. A number of studies quoted by the Sidran Institute suggest that between 20% and 80% of victims of sexual abuse in childhood do not remember all or significant parts of their abuse . The Author's research further indicates that the closer the relationship between the victim and the abuser is, the more likely the child is to repress her memory of the abuse. And the more frequent and more "penetrating" the abuse is, the bigger mental and neural damage the victim suffers, and the less likely she is to remember the traumas. The Author presents multidisciplinary studies that overcome the flaws of questionnaires. The studies consider clinical experience, physical symptoms, secondary aftereffects, and dissociative disorders, and convincingly demonstrate that the true prevalence of rape of girls by their fathers by far exceeds the purported 1%.
DISCLOSURE OF SEXUAL ABUSE
Clinical workers and scientists have noticed that there is underreporting of traumas because of dissociative amnesia . The victims mentally distance themselves from their abuse and lose the ability to correctly store the memories of the incidents. When the victims are asked later if anything happened to them, they are unable to remember. Furthermore, sexually abused children are often trained by their families not to disclose anything that is going on at home. The families are secretive about every aspect of their lives. This phenomenon is most noticeable in patriarchal families that are socially prominent. Typical examples are families of professors, doctors, judges, politicians, kings, and presidents. The dissociated children are controlled by their acquired habits and values, and protect their families against the outside world. The children project a semblance of impeccable normalcy, have the best grades in school, become valedictorians in high school, and graduate summa cum laude from college. Their drive to succeed academically may seem like an attempt to mask the horrible experiences of their childhood. This is not necessarily so. The children are usually unaware of their abuse. They reduce their world to a few activities and fully focus on one thing that matters to their families most: public manifestation of a healthy and honorable family. For these and other reasons, children who were abused by family members need extra time and support before they are able to disclose their abuse . The disclosure means breaking up with the family facade and seeing the world as it truly is. To commit such a betrayal is much more difficult for children who have been raised with the concept that an individual does not matter, but the parents and the family must be honored at any cost.
When children tell about their abuse, they do not come forth immediately after an incident, but need some time. It may take days, years, or decades before they disclose their abuse to others. If young children do disclose their abuse shortly after it happens, they use words and language that are reflective of the victims' cognitive development. They may fear that something is wrong with their genital areas, or that their bodies are dirty or damaged . A four-year-old girl who was raped told her mother that her father “had done things to her” . Young children do not know what to call their genitals or the abuser's anatomy or what to call the act of vaginal or anal penetration. Since children do not have the right vocabulary or understanding of what is being done to them, they may use incorrect expressions and sentence structures when describing such acts. These deficits are made worse by the children's emotional stress when the acts are described to a protective parent. For example, the mother comes home from work, and the child says in a thin voice: "Mommy ..." The mother does not hear it. The child repeats, "Mommy, Dad gave me a ... " The mother turns to the child, "What did he give you?" The child stutters: "He gave me ... he gave me .... kielbasa. I did not like it." And the Mom replies, "Oh, you already ate?" And she strokes the child's hair, saying, "I know that kielbasa is not the best stuff. I am sorry. Come, I will give you some cold cut and potato salad." And the child, who already gathered all her courage to divulge the simple line, feels misunderstood, unsupported, and unable to say any more. And chances are high that she will not mention the topic to her mother in the future, even if the child is abused again.
The general public as well as many health professional have misconceptions about child sexual abuse. It needs to be stressed that child rape and sexual abuse is not a medical discipline taught in medical schools. The physical manifestations of child rape are hotly debated by relatively few experts, and no medical school in the world offers a comprehensive program dedicated to the immediate physical and the long-term somatic, mental, neurological and social consequences of child sexual abuse. On the contrary, health organizations and medical schools deny and dismiss the symptoms of childhood sexual abuse, and ban practicing doctors from employing techniques that facilitate recovery of memories of child abuse. The same attitude exists in the government. Laws protect child rapists and enable them to repeat their abuse many times with no or just a token punishment. Had Josef Fritzl been executed right the first time he raped a woman, the recent Austrian tragedy would not have occurred. Similarly, had Phillip Garrido of California, USA been executed the first time he kidnapped or raped a woman, he would not have been able to kidnap and rape Jaycee Lee Dugard. In both cases, the governments and the common people have protected rapists from just and overdue punishment. Not surprisingly, none of the U.S. soldiers who raped and killed the 14-year-old Iraqi girl and murdered her parents and sister has been sentenced to death and executed.
Cover up of child sexual abuse is a social problem originating in families. The cover up happens both knowingly and unconsciously by dissociating from the devastating possibility that sexual abuse might be a reality. Dissociation of the potentially protective adults leads to dismissal, rationalization, and doubt about one's observations. For these reasons, protective mothers often associate symptoms that are indicative of abuse with other causes. Here belong the following categories:
CHARACTERISTICS OF CSA SYMPTOMS
Symptoms of childhood sexual abuse are very different from the symptoms of an illness. Symptoms of illnesses are usually visible or can be tested by reliable techniques. Symptoms of sexual abuse are mostly invisible or occur at private parts, which are normally hidden from others. In addition, because of dissociation, child victims of rape often do not remember their abuse and are unable to alert their guardians that something is wrong. These factors cause poor visibility of any symptoms. If the symptoms are noticed by a protective parent or by a concerned citizen, they have to be pretty obvious. This was documented in the 1990's, when sexual abuse of children was discovered in a religious preschool in Wenatchee, Washington. One of the women who came before the court as a witness was asked whether or not she saw any indicators of sexual abuse in the school. She resolutely denied that there were any indicators of sexual abuse of the children. In retrospect, one has to wonder what would she have expected to see if the abuse did take place. Would she have expected to see young girls running about naked with blood dripping from their vaginas and the girls screaming: "RAPE!"? Young children do not know the word "rape." Children do not understand what "sex" is, nor do they understand the rationel behind such yucky behaviors.
The described scenario seems silly, but realistically reflects most people's ideas about child sexual abuse. Molestation (inappropriate sexual touching and fondling) and rape (sexual penetration) happen secretly. The children are ashamed and do not advertise their penetration and subjugation. And blood is not normally present during rape. Most people have this vision of a torn hymen or anus with bloody panties and the child feeling uncomfortable in her genital area. She cannot walk or sit and is constantly irritated by the wound. Such symptoms are exceptions. After several sexual assaults, the genitals and the anus become adjusted to penetration and bleed no more or only very little. Similarly, after a few penetrations, the child numbs her sensations. The physical damage stops causing her constant discomfort, and a protective adult who sees such a regularly raped child finds nothing abnormal in the child's appearance, behavior, or mentation. And even if a mother found blood on the child's panties, she might attribute the finding to her daughter's menstruation, and not to rape.
Part of the reason for the failure to make an association between evidence and rape is that people who are in contact with an abused child find the mental image of a rape very disturbing. Incidentally, both incest victims and rapists prefer to use the term molestation. By converting the reality of rape to a vaguely defined word molestation, judges, juries, rapists, victims, and the public are able to mentally accept that a child has been treated inappropriately. Such a mild expression goes around the trauma of the victim and allows the involved parties to talk about it. No one, including the victim, wants to hear the naked truth and the details because that is where the devil is.
Research reveals that sexual abuse does not cause predictable symptoms and responses . This uncertainty affects both physical and psychological indicators. In one study, more than 80% of sexually abused children had at least some post-traumatic symptoms , while a different study found about one-third of sexually abused adolescents who had no significant trauma-specific symptoms . As for physical findings, they are often absent, even when the perpetrator admits to penetration of the child's genitalia . One team of experts evaluated children with suspicious anogenital (anal and genital) symptoms and found that 84% of children had no findings that would be suggestive or indicative of abuse . A different study examined 2,384 children for alleged sexual abuse and found that 95.6% had entirely normal examination findings despite high likelihood of having been abused . And Biggs et al. found that only 9.1% of raped females with no prior sexual intercourse had hymenal perforation . Even more stunning results were found by Kellogg et al. They identified definitive symptoms of penetration in only 2 of 36 pregnant adolescents . This lack of symptoms explains the origin of the religious term "immaculate conception."
But if sexual penetration of the vagina does not provide a reliable indicator of abuse, what other signs are there? There are many visible signs and aftereffects that are indicative of sexual penetration or sexual abuse in general. The problem is that the indicators are not absolutely persuasive. They only provide hints and suggest a high probability of abuse. There is no certainty, because the symptoms are interpreted by people who do not understand the symptoms or do not want the symptoms to be symptomatic of sexual abuse. This type of symptoms includes major vaginal tears, and even pregnancy. If a juror or judge does not want to believe that the tears are the result of rape, the symptoms prove nothing. If pregnancy occurs, the defense layer, the judge, and the jurors may rationalize that the sex was consensual. One needs to understand that people who rape children or are victims of childhood rape do not want to see the symptoms as indicative of abuse. But the more indicators a child has, the more likely it is that she has been abused. In addition, most symptoms of abuse are psychological and are not easy to notice or correctly interpret. Psychologists and therapists have collected many of these symptoms. There is "no proof" that they are truly caused by child sexual abuse, but can be seen over and over again in children who are known victims of sexual abuse. The significance of the symptoms is that they have nothing to do with the actual abusive act. They are secondary aftereffects that are triggered by the shock and stress of the sexual abuse. You can sew up a torn hymen or perform a secret abortion on a pregnant girl to cover up her abuse, but you cannot hide her psychological indicators without killing her. The explicit knowledge of abuse is hidden in the mind of the victim and the abuser. This is why American lawmakers have universally banned the use of lie detector tests in the legal system. Can you imagine the scandal if you could prove that a daughter of the President or other leading politician has been raped by him? Can you imagine the scandal if you could show that a Judeo-Christian patriarch has raped his child? Of course, this scenario must never be allowed to occur. Both Democrats and Republicans have enacted laws to make sure that rape in the family remains hidden from the public. For the same reasons of personal protection, federal lawmakers and judges have decreed that rape must not be punishable by execution of the perpetrator.
HIGH LIKELIHOOD SYMPTOMS
CONSEQUENCES OF SEXUAL ABUSE
The consequences of intrafamilial rape, acquaintance rape, date rape, random rape, or gang rape can be deadly. The immediate concern after a brutal rape is the physical health of the victim. She may have serious vaginal tear and may bleed to death if she gets no medical help. She may develop blood infection. She may acquire common, but also sexually transmissible diseases, such as chlamydia, genital herpes, syphilis, gonorrhea, human papilloma virus, or AIDS. She may become pregnant and may be forced by the state to deliver her rapist's child. In addition to harm to her sexual organs, she may be beaten, mutilated, or crippled, and may spend the rest of her life in a wheelchair or in bed. Or she may fall into permanent coma or be killed.
The long-term consequences of sexual abuse are usually of neuropsychological nature. The victim may develop post-traumatic stress disorder and suffer from fear of going out, meeting people, sleeping in the dark, being in small enclosed spaces, or being alone. She may have recurrent flashbacks, exaggerated startle reactions, extreme fear of being touched, kissed, or looked at in a sexual way, or any other way that signals interest in her. These fears and phobias are likely to stay with her for life unless she undergoes thorough psychotherapy.
If the victim is a child and if her abuse is long-lasting, she is likely to forget about her ordeal, but her subconscious mind will remember and will steer her life. She may never learn why she behaves the way she does. She will tend to reenact the abusive environment of her painful childhood and is almost certain to marry a child rapist and let him abuse their children. Because of her psychological distancing from her childhood traumas and her contemporary traumas, she will not recognize her partner as abusive. She will trust him blindly and will unconsciously do her best not to discover intrafamilial rape in her home. In this respect, she will react to intrafamilial rape just like her mom did.
A frequent consequence of rape in childhood is the victim's desire to have her hymen restored. In essence, she wants to be a virgin. This desire to turn back the clock manifests the victim's neuropsychological damage. The rape may have caused her minor physical harm, such as a torn hymen. This damage is hidden and inconsequential, and has neither aesthetic nor health effect. It is the mind of the victim that needs major restoration. The victim has no idea that she has suffered neuropsychological damage. The desire to have her hymen restored indicates the victim's dissociation. She hopes that by having an intact hymen she can make a new start in life. This wish expresses her subconscious value system. She sees her worth only in her ability to provide sex and in being a virgin; that is being sexually desirable. After her hymen is restored, she forgets that she was ever abused. Years pass, and she becomes an adolescent. She believes that she is still a virgin and is overly concerned with the protection of her virginity. Before she consents to sex with her partner, she carefully evaluates him. He must be perfect. Unbeknown to her, she is attracted to a partner who has the behavioral characteristics of her intrafamilial abuser. Her damage is mental, and not physical. Having her hymen sewn back together has absolutely no effect on her neuropsychological healing.
Because of the victim's tragic interpersonal experience, she may forever remain single or may marry a person whom she does not like. Her self-esteem can be nonexistent. She may be shy in every aspect of her existence. She may oppose happiness, believing that in view of her tragic experience, which she does not remember, she has no right to be happy. She may avoid people, friendship, love, and sex even decades after her trauma.
In parallel with posttraumatic stress disorder, the victim may develop serious dissociative conditions. She is likely to permanently lose emotional intelligence and suffer from frequent intermittent gaps in concentration and consciousness. She may develop sensory deficits, such as psychological blindness or deafness, or even paralysis. The usual label for such disorders is hysteria.
The victim's mental condition is likely to damage her physical health over time. She may develop illnesses that are associated with high-intensity chronic stress and are the leading causes of death. She may develop various psychosomatic illnesses and die in young adulthood or in middle age. She may be acting out; that is behaving impulsively and dangerously. She may join the police or military and die on duty. Or she may try to reach for the unreachable star and kill herself that way. Her mental illness and unresolved childhood abuse may draw her to dangerous situations or partners. Her lifestyle and abuse of drugs, food, alcohol, cigarettes, stress, high demand, or other agents may cause her death in accidents, overdose with prescription pills, drug overdose, or suicide. She may live for one goal: to be busy all the time. She may die of exhaustion or of a heart attack.
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