Sexual Abuse - Protecting Young Men And Women From Abuse  Pat Cox

I am going to be talking today about protecting young women and men from sexual abuse, I am going to be talking about how we use knowledge and understanding to protect young women and men from abuse and I am going to be talking about how I believe knowledge comes in waves, I am going to be using the metaphor ebbing and flowing rather a lot. I am going to talk about where we are now and what I think we can do about that. Inevitably I am also talking about a very complex nature of knowledge, I am actually talking about that by default, I am talking about what we know, what we let ourselves know, what we allow ourselves to know and I am talking indirectly  about how many forms of knowledge are privileged over other forms. For example, knowledge that is written down or printed is privileged over the knowledge which is spoken. Men’s knowledge is often privileged over women’s knowledge, that of white people is usually privileged over that of black people, that of able-bodied people is privileged over that of people with disabilities and last but not least adult’s knowledge is usually privileged over that of children. What I am going to be talking about today is mainly backed up by existing studies and research. This is a different sort of presentation, as I said my background is social work. It’s very much about thought piece, it’s about where I am, what I am thinking about, what I am writing about.

I think in audience like this I don’t really need to go into the history of child sexual assaults. We understand that it’s going on across cultures, across centuries. We can go back as far as Ancient Greece, we can go back into the legends and stories of the Eastern world, we can come forward in time to medieval folk songs, we know that historical accounts have been recently reclaimed, we know it’s gone on and it’s gone on everywhere in fact thank Professor Yordan for this for leading me in that it’s still going on everywhere.  What is important I think is that knowledge and understanding about child’s sexual assaults is moving constantly in waves and if we take any historical perspective we are looking at a wave coming up, we are looking at understanding developing and this is repeated circuiting, repeated kind of driving up into public awareness and professional consciousness and then there is a negative reaction, and a wave ebbs off again down the shore.

I think that in the 1990s we are in great danger of not building on where we know now, I think we are actually almost at a peak kind of in knowledge and understanding. What my concerns are that we are not building on that, we are not using knowledge effectively, we are not publicising knowledge effectively and I am very worried that if we don’t build, we won’t stand still we’ll actually start to lose what we’ve got and we’ll end up with strategies for protecting children that are at the very best apolitical and quite adult-centred and at the worst much much worse than that, certainly not child-centred.

I’d characterise, a quick flick through history here, I apologise reading stories in the audience, I’d characterise the period of the 1970s and the 1980s as a great period in public and professional awareness. We know that the credit for raising consciousness about child sexual assaults in these years goes to many unknown black and white women working in women’s refuges and rape crisis centres, this knowledge was picked up in varying place in varying times by social workers psychologists, youth workers, paediatricians and we are now at a point where a great many of us recognise child sexual assault as a root of a great deal of childhood disturbance and at the root of a lot of adult pain. The 1970s and 80s are characterised by individual survivors speaking out, by research, by the developments here in England for example of child line, the help line for children, various films, soap operas running story lines about child sexual assaults and a message reaching a much wider public than previously.

I’d say that in the 90s we are lazing a bit. I think that the pronouncements of for example Peter Lilly and John Redwood when the last government was in power about the abuse on single parents’ of the Child Support Act for example shows that they have no idea that someone would choose to live singly with their children rather than living in a two-parent household with an abuser, I felt it was deeply significant that the media treatment of the Department of Health messages from research in the media the response focused much more on what was being said about social work practice than on what’s being said about abuse Reports that came out in ’95, feasibility study about ascertaining the prevalence about child sexual assaults in this country did not get any news coverage whatsoever, that to me says what’s happening to that knowledge.

I want to talk about very broadly it will have to be and I apologise for that I want to talk about studies and research. Studies have been going on for a long time now, 70s and 80s were kind of peak time for this, and all the studies and all the research tend to use different definitions of what child sexual assault is or isn’t, tend to use different audiences, tend grade the  data differently and so on, you know all this, I don’t need to go through all this in too great a detail. But what is interesting is when you start to look at these studies en mass and when you start to look at study of studies what we see is commentator saying things like, and this is back in 1990 now this isn’t a recent comment, “there is been enough research to show that the sexual abuse of children is not a negligible issues or a question of public hysteria but a serious social problem, even the lowest estimate of its prevalence indicates the large number of children are involved”. That was an English commentator in 1990 and more recent commentators have said things like, “a huge fundamental question of policy, practice and prevention”. These studies and research, this is if you like in a category of official knowledge, it’s written down, we can access it. There is also I think a lot of unofficial knowledge and I think that perhaps we may, we cannot say in confidence, but we know the true numbers and young women and young men who are sexually assaulted and we may never know that.

Commentators had indicated how it is for young black women and young black men to speak about sexual assaults because it may mean an involvement of the police and as we know policing in this country is very heavy-handed and often very racists. Young lesbian women and young gay men find it difficult to speak out about being sexually assaulted because of the heterosexism, homophobic oppression that they daily experience and we talked about it this morning. Young women and young men who are disabled very often can’t communicate directly, you may not have the power of speech, the language that they use to communicate may not have the terms for sexual assault.

In relation to understanding about sex rings and understanding about international sex tourism and our understanding about abuse generally we are at the bottom of a very steep learning curve, we just don’t know enough about all this yet. Pornography, that was another thing, this is the extent and state of pornography and involvement of children in that who have been abused, we are learning but we don’t know, so it is difficult to say exactly what we are talking about. What we are clearly talking about are huge numbers and when we’re ask about the fact that we know that people who commit sex offences very rarely will own up to all the offences they’ve committed, we’ve got another figure, another hint figure. And the fact that survivors don’t know to talk about everything that they’ve suffered and sometimes they can’t because they are into forgetting as a defence mechanism.

So we’ve got a lot of information, a lot of it official, we’ve got a lot of information that we recognise but we can’t get at right now and yet it’s still very difficult to get policy - makers to kind of take on board the issues of child sexual assault. I think there are two things around it, I think that there is prevalence that I just talked about, I think it’s very hard for all of us, people in this audience than let alone the wider public to get our heard around something so wide-spread, so wide-scaled and something that’s gone on for so long. I think that it’s also and this is again difficult but all the studies that have looked at the issue of gender, and again Professor Yordan led the way for me on this all the studies that looked at the issue of gender show that overwhelmingly that it’s men and it is men in families who are committing, who are perpetrating these offences. It’s difficult for all of us. It’s difficult for women to take this on board, it’s difficult for men, whatever our sexual orientation, whatever our relationships with our own sex or the opposite sex, it is very difficult to get to grips with it this gender nature.

We are into the politics of gender, we are into the politics of heterosexism and we are into the large large debate for the full picture and I think that it does make it difficult for all of us. I think that it’s easy therefore for a lot of us to express our discomfort with all of this in challenging studies or disagreeing with studies or saying, you know, this doesn’t really exist, we know everything there is to know, we’ve got it all under control, various responses. We’ve all heard them sometimes, we may be guilty of making them. I think there is resistance to knowledge. I think that we are talking, I don’t really like the description which is used by an anthropologist, he talks about public secrets: we know this and we don’t know this, and we sort of don’t know ourselves into denial. There is resistance, there is avoidance of these public secrets.

What we have to do particularly those of us who have access to both the official or privileged knowledge and the non-privileged knowledge which is a lot of us in this room is we need to be talking more widely about this, we need to be saying, this is a major issues, this is a major social problem, we need to be talking, I mean talk to anyone and listen, you know, I mean, talk to, a lot of people want to know more and don’t know what to ask, if you kind of let on that you know a bit you will get asked questions. I think that it’s important as well that we correct misapprehensions in the media, I think for example the way the media is treating in this country the enquiry into abuse in children’s homes in Wales it’s very much re-enforcing this notion of individual men who are abusing and I out this in inverted commas I am not happy with this word, individual paedophiles, dreadful men, you know a long way removed from normal people, normal men. And we need to start correcting this, we need to start saying, hey you know, we are not talking about individuals, we are talking about large numbers of abusers.

In this we can be helped,  people like David Finklehorn have led the way saying we must rebuff, we must refute, we must engage with the audience, we must get people on our side. There’s recently been stuff written by two practitioners who work with sex defenders and they’ve got a lot of practical advice to offer the rest of us about getting journalists on our side and getting our information into the public arena. To get to grips with it we have with the prevalence, we have to get to grips with the gender politics, because I think if we don’t I think it will all disappear again, it’s already, I don’t hear these debates very much anymore, I do hear them , but I don’t hear them as much as I did. And I think that I will wholeheartedly agree with Professor Yordan and as you see I do about the widespread nature of child sexual assault. I think that we can accept that it is widespread but we don’t have to accept that it is the way that it is always going to be, that it is inevitable. Thank you.

Ann Sutton: I understand that Doctor Vivien Norris and she can’t co-present. Michael Maher is going to present Self-harming behaviours and group processes in adolescents residential settings. Michael was formerly deputy director of Peper Harrow, a residential therapeutic adolescent community, where he worked for 6 years until 1992 and is now a group analyst with a continued interest in residential care and treatment for adolescents. Thank you.

Self-harming Behaviours And Group Processes In Adolescents Residential Settings

Michael Maher

There have been a number of very deep and very intense presentations on some difficult subjects I just want to pick up on the last talk though in terms of turning away from knowledge some thing I agree with very much and from a different perspective because  I amore concerned with the treatment the care and treatment needs of adolescents who have been sexually abused to abused in other ways as well. Personally coming from a therapeutic community background working with such adolescents who have extreme conduct disorders and many types and you are all going to hear and presume people will understand the type of kids I am talking about to be working in that situation and then for that institution to close is a very personal reaction I have to what felt at the time like a deliberate turning away, because not only it is about public awareness about the extent of this, there is also a very very big question what do you do with these kids? Where is the treatment resource?

And it’s not just these kids it’s also these adults, these adults who then grow, these men particularly who grow into the adult personality disorders issues of violence that go along with that which could be addressed at an early stage and which have not been. And I think particularly the things that have gone hand in hand in the last 10 - 20 years in terms of things that go wrong in attempts to treat kids particularly in residential institutions like in North Wales have been used as an excuse to close down hell of a lot of places that are trying to do things. And there are some places where things did not go wrong and I’d like to talk a bit about it now.

My colleague Vivien and I both worked at Peper Harrow until it closed about 6 years ago now. Vivien’s gone on to train as a clinical psychologist since then and I’ve trained as a group analyst and this is an attempt to integrate two perspectives on a type of self-harming behaviour and I am limiting myself to cutting, OK. Vivien‘s done a piece of research with young people mainly girls and the vast majority of young people who self-harm in this way are girls, and she did a piece of research in 3 places: therapeutic community, a community home and an in-patient adolescent unit.

Cutting often starts in adolescence and in in-patient unit this is very prevalent up to around 40% is suggested. When I am talking about cutting I am talking about the type of cutting which is distinguishing suicidal behaviour. I am talking about are repetitive and of low lethality unlike severe self-laceration which can be associated with psychosis. There is growing consensus that this type of cutting can be distinguished from suicidal behaviour so in this I am departing from the approach that you took looking at a more broader aspect. And many adolescent will start cutting while in in-patient settings. In her research which came in 3 main areas Vivien looked at explanations of cutting, the impact of cutting on others, some of it I am going to miss that bit out, and responses to cutting and how they are experienced by young people. And she came up with a model which I will go through, and then I want to say something myself which is my perspective in response to the work that Vivien did and this is going to be again a brief summation of that.

The explanations that come from talking to the young people and the people who are attempting to care for the  young people were divided into these categories: that they were survivor strategies, as a way of  avoiding suicide, general coping strategies that came under a number of headings that I don’t have time to go through, behaviours which were orientated towards calming and agitated state, release of tension or distraction from very painful feelings, issues which she grouped under terms of self-hate, punishment and internal  anger attacking self in a very visible way about feelings of worthlessness, feelings of responsibility, feelings of guilt and a very common one about making concrete bad things from the inside to the outside, so I look normal on the outside, but I feel anything but normal, if I do this to myself and often people will know my arms that take the brunt of this behaviour then I can show that I am not, how I look corresponds more to the sense how I feel,  I am not normal.

Now those were intrapersonal explanations and just the some kind of knowledge of value over others, some kinds of modes of being of value I mean where we find ourselves now, the individual and the intrapersonal is valued above the interpersonal, I think that’s a universal phenomenon. Those interpersonal explanations which were offered came around things, issues like communicating distress, punishing others and attention and status. Interestingly no person who cut themselves ever attributed interpersonal motives for the reason. So no kid that Viv ever talked to as part of this study said, I do this as a way of communicating to other people. All the explanations were all intrapersonal, all about personal feelings, very vehement about it not being about communication.

What of the staff reactions. What you have over a period of time is the member of staff who has attempted the rescue which is failed over the period of time. What the would habitually do is start to defend themselves against that experience. The member of staff would stop entering in to have their hopes dashed. And they’ll stop attempting themselves, and they’ll start becoming more cut off from the kids, more distanced, more arms-length. That will be about being angry, about being you know these kids are not getting well, there is no gratitude, it’s being thrown back in their face, all this work I’ve been putting in and look what they do, you know, well, thanks a lot. And I’d certainly felt like this myself and I’ve seen that many times, oh, you’ve cut yourself again, and a lot of people in here when the kids you know either go to A&E, the things that they hear is why don’t you do it properly, they get stitched up without anaesthetics, they’ve got a lot of rough handling, let’s encourage them you know out of this cutting behaviour, very very terrible set of feelings, very similar to things about suicide, you know, we are here to help people, we are not here to be messed about by people. So you have anger, you have a cut off response, withdrawal, rejection and anger and that’s a very powerful and self-feeding cycle.

What Vivien and I suggest is a answer to that is the need for a physician which falls into neither of those loops, sides of the loop. But if you go for a heroic rescue attempt you are bound to fail and you’ll fail the child. If you cut yourself off from the painfulness of the feelings then that’s kind of professional rationalisation of having come to work every day who will have the same effect, it’s a feeding cycle either way. What we are aiming for in our advice to staff who find themselves in this very difficult situation is to find a place of being suspended in the middle, aware on the pulls on you to react one way or another, to go into either of these fairly comfortable positions but to actually stay in the middle of the dynamic forces, such a place referred to as negative capability when writing in a different context is about being able to bear unresolvable tensions. This is not possible to resolve this, not in action.

I’ll give you a quick story and I’ll stop. In action what would might this look like being neither controlled by either impulse. One night I was a senior member of staff working that night at the Harrow and it’s been a fairly OK night in my terms and kids have gone to bed at a reasonable time or it seemed like they had and I’d gone home maybe even before midnight which was great and then I got called back in, the phone went and my heart sank and I am running back in and I lived close by and I got back, I got in there and there was a scene of mayhem and there is this girl who I’ll call Katy who had a history of self-harming, cutting herself and what she used to do over repetitive times, she’d been in the community quite a long time, she’d been there about 3 years and she’d made a lot of progress but she had this pattern, she would get out, she’d drink until she was very drunk and she cut herself and then she’d talk. The rest of the time she was a very silent character, very difficult to know, non forth coming, sexually abused as a child and very very difficult to cope or deal with through words any of the residue of that that she’s been left with. So I came in, Katy was drunk, drank very large amount, had cut herself really really badly, very deep in the arms and there was a lot of blood and she gone up on the garage roof and then she’s fallen off. So she bashed herself on the side of the head with all her arms in a really terrible state and all the kids were up then and there was high drama and you know I was called in and everyone was looking at me, what are you going to do?

And the other thing was that she was refusing to go to hospital, I won’t go, she said. She was losing a lot of blood and the kids panicking, and the staff panicking and I am panicking, you know and so we got to work. Some of the staff were trying to contain the anxieties of other kids and some of the staff were so involved, they were trying to talk to Katy and say, you’ve got to go to hospital. Eventually, over a period of time and sustained pressure, she said, OK, I’ll go to hospital, but I’ll only go to hospital in Kevin takes me. Kevin’s a member of staff, he was on that evening, he was there available, she had a special relationship with Kevin, it’s mostly good but there is something about it which is difficult too. And that part is the unspeakable part, OK. That part of her in which she is attracted to Kevin and also in which Kevin reminds her of the man who abused her. Now I felt very strongly on an intuitive level at that time that she must not go to hospital with Kevin. I thought there was something about her re-unitement back illusion with the parents, the kind of system that gets set up in the abuse in the first place in which you find it nearly impossible to do anything else. And I though I was in a position where it’s nearly impossible to say no to this because we have chaos, we have high drama, we have blood and violence and all this kind of stuff and here is an answer.

So I took a deep breath and said, no, you can’t and then suffered the anger of everybody, all the kids and the staff as well. And eventually it’s kind of grounded out in which Heather took her, Heather was another member with whom she didn’t have particularly special relationship, but it was OK. And eventually we got to that point and eventually she went to hospital and she patched up. Now I think what I was doing then was not being pulled in, not allowing myself or my staff to be pulled in to either of these cycles. I wasn’t rejecting her, I was not giving the slap response, I wasn’t manhandling her, or calling the police or getting her sectioned or something like that, that would have been one way, I guess, you know, the kind of a hard way, the hard-edged way of dealing with that situation. I wasn’t doing that, neither was I taking the easy way, neither was I going in to the pathology of the situation and reinforcing something. And that’s a very small example, but I do think that kind of being able to stay in a very difficult place to be not pulled into either of those directions by the need of a young person or  by the needs of the group is the way which I would say you have to work if you are going to have any success with this type of young person. Thank you