The article that follows relates to that conference. 

Physical, Sexual, Emotional - The effects of violence on (against) the Adolescent

A. Developmental Issues 

The effects of violence  - be it abuse, aggression or indirect violence {definition} may be seen in adolescence while having origins at an earlier stage of development.

Infancy -  

The baby/ infant may be subjected to anger, rejection and be the focus of negative emotions which will impact on emotional development of the individual. It is here that object relations, the basis of all future relationship with the outside world and other living beings, are formed.  

To outline rather simplistically the concept of object relations the following quote from ‘Inner Worlds’ is appropriate –

“The baby asks for attention by crying, smiling, coughing and later vocalising. A fortunate child will receive an appropriate response which makes sense and thus aids his understanding of the world, whereas the unfortunate baby will receive the 'wrong' response or no response, leaving him confused and disturbed. We all receive some inappropriate responses since mothers are not perfect and the needs of a child can be easily misunderstood. A child's demands must also to an extent be frustrated if he is not to continue as a demanding omnipotent tyrant. 

The mother will be seen by the child as being good, nurturing , provider of all nourishment, when she is meeting the baby's needs at times such as feeding. In Kleinian terms, she is then seen as the 'good breast'. When she is withholding, frustrating the child and not fulfilling his needs, she is seen as the 'bad breast'. 

When mother is doing something good, she is good, and when someone is doing something good to you, you feel good, you become good. Hence the good part of mother becomes part of the inner world of the baby. The same happens when mother is being 'bad'. Hence good and bad sides of mother represent 'internal objects' for the child. 

At first the child cannot integrate these together. A young baby can adore the 'good mother' and then murderously hate the 'bad mother' without being able to see that both are parts of the same person. Later he may fear that he has harmed or destroyed the good while attacking the bad or that he may have exhausted or consumed the good breast by his greedy demands.  Keeping these opposites apart is useful in avoiding the conflict inherent in integration but stops the child from developing a well functioning inner self.”

Some of us never quite manage the integration of good and bad elements or use the split to cope with stressful situations, disowning the parts that do not fit with the currently felt emotion. If you are feeling anger or hatred for your mother, something taboo in 'nice' society, it is convenient to see her as totally wicked and neglectful, to completely disregard the loving, caring side which does not accord to your present view. You can't hate her if she's good, but you have permission to hate her if she's evil.  This conflict – particularly if fuelled by abuse and violence during childhood is a breeding ground for personality disorders and behavioural problems which we then see emerging in adolescence and adulthood.

The relationship between the individual and the mother figure / parent figure is central to all future emotional development and particularly the way that negative emotions are dealt with.

Mother as Container

The mother is the container of positive and negative emotions for the developing baby and provides a ‘buffer’ zone, tempering the effects of negative feelings and reflecting them onto her child in an attenuated and thus manageable form. If the mother is unable to fulfil this function for her child - by virtue of being emotionally unavailable, distant, depressed, mentally ill or rejecting of the child - the baby will feel the full brunt of negative emotions at a stage when these may be too powerful to deal with - emotional damage - emotional abuse will thus occur.

Mirroring  

To Quote again from ‘Inner Worlds’ –

 “… we know ourselves by virtue of the reflected aspects of ourselves which we receive from other people. Winnicott beautifully described the mother as the mirror for the infant. He spoke of a mutual adoration between mother and baby whereby the child was able to express his feelings towards his mother who reflected them back in a way that could be incorporated into the child's developing self.      If the mother acted as a faithful mirror accurately reflecting the child's feelings and relating to him as a new unique individual whom she loved, then his true nature would flourish, he would develop as his 'true self'.    However if the mirror was flawed and instead of reflecting feelings, projected something different, the mother's fears, mother's worries, mother's hope that the child would somehow conform to, a mould of her making for him to fit into rather than his own space to grow in. If such a false image was projected back to the child, then he would forsake his 'true self' which was being rejected by his mother and instead, develop a 'false self' which his mother might love.” 

  The Wall

 The true self becomes locked away, walled up -

 - in the words of Roger Waters  -

      "... Mother's gonna make all your nightmares come true, 

            Mamma's gonna put all of her fears into you,  

            Mamma's gonna keep you right here, 

            Under her wing 

            She won't let you fly but she might let you sing 

            Mamma will keep baby cosy and warm, 

             Ooooh Babe, Ooooh Babe, Ooooh Babe 

             Of course Mam'll help build the wall ...." 

In the extreme situation the mother may actually be abusive to the infant - and this abuse may actually begin in utero and continue into infancy and beyond. The developing psyche of the child may traverse many avenues of abuse prior to the effects coming to the fore in adolescence. 

Childhood 

Violence occurring in childhood profoundly affects the adolescent  whether it be violence perpetrated on the individual or witnessed violence within the family or society. Family structure and family behavioural patterns lay down ‘blueprints’ for behaviour, values and emotional functioning. These can be looked at from various perspectives – for example the concept of ‘life scripts’ – dysfunctional patterns and boundary issues all play a part.

 Effects of Violence

How do we understand the effects of violence? The dynamics of the situation could be see thus - an initial act of aggression or violence perpetrated on the child will produce feelings which may or may no be openly evident. Some feelings may be covert and gradually build up to produce inner tensions and conflicts. The overt and expressed feeling may be that which is acceptable within the society or family grouping of the individual - that will accord with the current expressed behaviour patterns of the child. For example the child may feel fear and act timid, retiring or wet the bed or the child may be angry and jealous and destroy a siblings toys.

 Initial Act                                                        Resultant Act 

 Agression            Feeling             à Shown      Current behaviour

                                        à Covert      Future behaviour 

The covert feelings which may be unacceptable in the family are those which may surface later in adolescence and can be the source of more extreme and perhaps harmful behaviour patterns and psychological pathology.

The following model is useful in discussing the effects of physical violence on a child.

  Energy Levels

The lower the ‘energy level’ ie less able to adapt, lower resilience and flexibility - the higher the passivity with more internalisation of feelings - anger hatred, lower self worth, lower coping skills  and thus the more likelihood of self hatred, self harming behaviours.

As abuse / experience of violence becomes more frequent and more commonplace the individual may become more hardened and ‘acculturated’ to the experience and thus more fixed in the adopted role or behaviour pattern of behaviour and feeling.

  A pivotal point

In terms of the ‘cycle of abuse’ - The adolescent is at a pivotal point between violence received as a child and violence given to (own child) others.

Violence received as a child     ß Adolescent à Violence given to own child

Types of Violence 

Violence within the child’s environment can take several forms all of which impact on future well being.  Direct violence to the child (abuse); other forms of abuse (emotional etc) ; violence between family members; violence witnessed outside the home; ‘Covert’ violence eg rough play. 

Types of Violence 

Direct Violence           - Direct violence to the child (abuse);

                                  - other forms of abuse (emotional etc) ; 

Witnessed Violence     - violence between family members; 

                      - violence witnessed outside the home; 

                     - Media violence 

‘Covert’ violence           -  rough play 

                      - made to do things don’t like? 

In play a child can be learning about how to handle violence and aggression. We see animals, puppies for example play fighting and learning how to cope with conflict. Children do the same and adolescents also test out boundaries and ‘play fight’ certain situations in the safe environs of the family and friends. When these limits are extended and breached however, problems arise. The fight that gets too serious, the rough play that ceases to be fun and causes tears. The tumble on the carpet that stops being a lesson in physical closeness and becomes a sexual grope. The game that is no longer mildly competitive and becomes dominance with submission.  

Advantages                                                                                Problems 

Social                           ß        Rough Play                      à        Bullying 

Grouping                      ß        needs boundaries          à        Domination 

Learning skills            ß           protection                     à        Submission 

Fun (for all)                  ß        ‘rules’ of game              à        Boundaries reached 

Dominance

When dominance becomes a factor – then cruelty and bullying creep in. How do we tell when this boundary is breached? If the behaviour is for the satisfaction or gratification of one to the exclusion of the other, if one has to be ‘put down’ – then this is bullying – there needs to be equality in play and maintenance of boundaries. Otherwise there is a point where the acquisition of positive skills is replaced by learning negative behaviours.  

+ve skills   ß    à  -ve behaviours 

Another example is in the learning of social groupings – a positive learning experience can be replaced by the negative modelling on gangs. 

Learning abusive patterns – copying with family violence.  

Violence in the family has a very high level of persistence from one generation to another.  Maltreatment of children has been shown to increase levels of violent crime perpetrated by adolescents by 24% ; violence between parents was a factor in the history of 70% of violent adolescents and those exposed to multiple forms of violence – ie within family members and to self – had double the rate of violent crime (at 75%) than a control group in the Rochester (USA) youth development study. Similar trends – although with lower overall rates – have been experienced in other countries.  

However  ‘ the number of potential psychological casualties of violence far outnumbers the physically wounded seen in emergency rooms’  Here lies a source of adolescent disturbance and behavioural problems. Social factors such as family poverty, stress, overcrowding and homelessness also play their part here.  

Abuse in childhood also increases the risk of drug and alcohol abuse – an article in the International Journal of addiction (Vol 29 1994) on ‘Childhood victimisation and the risk of alcohol and drug arrests’ (Ireland and Widom) concluded that childhood maltreatment is a significant predictor of adult arrests for alcohol and drug offences and there was a 39% increase in juvenile crime in this group.  

Case History – Ingrid lived in a very violent household. Mother and father frequently fought and her older brothers were all violent. Her father and brother were alcoholics. Ingrid was abused physically and sexually. She was placed in children’s homes at various stages in her childhood where she was also abused. Ingrid became a mother herself at the age of 14 and had another child two years later. She was by that stage earning her living in prostitution. She moved around the country with her two boys avoiding the authorities and progressing from one violent pimp to another.  She abused alcohol and drugs. The boys were cared for erratically, they were not deliberately abused but did suffer neglect and had various ‘accidental’ injuries.  

Ingrid decided to try to change her lifestyle after a close friend was murdered by her customer. She acknowledged that she had often placed herself at risk of severe injury and she was afraid she would die. When the boys were taken into care of social services their behaviour echoed their mother’s obsession with images of violence. They fought other children, destroyed property and in play therapy when given a doll the six year old boy tortured the female image and then ended the play by crushing her head in.

A sad example of patterning on family disturbance and childhood violence. Several years later the family are still functioning in the same disturbed manner and the boys are sociopaths.

B. The Scene in Adolescence 

Adolescents as victims of crime   

Adolescents are affected by their childhood experiences of violence – but are also the victims of violence during the adolescent period itself. 

Living in a culture of violence is a serious factor here – most adolescent victims of crime are from the same background and have similar profiles as their assailants. In the USA it is estimated that teens between 12 and 19 form 14% of the population over 12 yet they are the recipients of 30% of violent crimes. The situation varies considerably from one culture to another.  

Adolescent reaction to early violence and abuse –  

Case Histories –  

Adolescent drug / alcohol abuse and self harming 

 Lisa had been severely abused by her father. At the age of 16 she disclosed the abuse to a teacher following which event her father set fire to the family home and died in the blaze. Lisa was given compensation from the court for the abuse she suffered – but unable to deal with the guilt of her father’s death for which she felt responsible, and the guilt of the abuse victim – feeling somehow further abused by being ‘paid off’. She spent all her considerable compensation in a drug and alcohol binge, was arrested several times on the streets drunk and having committed minor crimes.  She self harmed in several ways and when admitted to our unit had cut her arms from top to bottom and was on twenty four hour suicide watch. Lisa took several years to be able to cope with life – she had intense therapy directed at her very low self image. 

Carol had a similar history of severe abuse. She was sexually abused by a number of family members and then sent to a very punitive residential facility for her ‘protection’. In adolescence she acted out very badly becoming drunk, using drugs, cutting her arms and living a very violent life on the streets. She threw herself in the river twice and fought with police who tried to save her. 

Familial Violence –  

 Helena had a violent father who beat her mother regularly. Her brother was also violent and she described him as a pig. When she eventually ran away from home at 15 she met up with a fairground attendant who had a similar background. They began by being supportive of each other – two abused children together – but within a month he was beating her severely. She made several visits to hospital with broken bones but always went back to him. The patterning of violence was so strong for her that she was continually drawn back to a violent environment – even after finding a caring boyfriend who begged her not to go back – she ran away back to violence and further injury. 

Lack of Communication

Adolescent violence can stem from frustration and lack of adequate communication. This feeling of not being heard, not being taken seriously coupled with impulsiveness and risk taking behaviour can result in both self harming behaviour and harm to others as well as violence to property. 

Case History -  Sarah had been sexually abused by her grandfather since the age of 4 or 5. In common with many victims of sexual abuse, she was unable to 'disclose' what was happening. She at the same time could not believe that people - her mother, her aunt and her grandmother could not 'see' her distress  and acted as if they did not know.  

She began to act out the anger and frustration she felt in delinquent activity - smashing windows on her estate and minor acts of vandalism. This did not get her into trouble, people did not seem to notice. There was no consequence to her behaviour - just as there appeared to be no consequence to her grandfather's behaviour. 

Later, as an adolescent, Sarah's rages became more intense. She walked a long distance with a knife in her hands, wanting to kill her grandfather. When she arrived she saw her grandmother and could not commit the deed. She thus went home, smashed the family home and was committed to a mental institution. She calmed down and was released. Another example of missed communication. 

Later during therapy she went into an 'uncontrollable rage' one night and smashed windows in the treatment unit. The following day she doggedly refuted that there was any possible consequence to her behaviour. A breakthrough in therapy occurred when she was faced with possible consequences and a code of 'acceptable behaviour' was laid down. It was as if at last 'it mattered' what she did and therefore 'she mattered'. 

Munchausen

Munchausen  syndrome can also be seen as a persistent pattern of violent response. Amy was abused by her mother in a form of Munchausen by proxy. As an adolescent she had a dreadful fear of death and would self harm and indulge in various attention seeking behaviours. When she became a teen mother she attempted to suffocate her child and admitted in therapy that the only time her mother had ever held her was when she herself was suffocating.  

Responses to sexual abuse / violence  

In addition to the factors already discussed, sexual abuse and sexual violence adds another dimension to adolescent behavioural patterns. 

 Sexual Experiences – learning   à Roles 

                                                à Patterns of arousal 

                                                à Patterns of behaviour 

During childhood and adolescence the individual learns sexual roles, patterns of behaviour and patterns of arousal are laid down in the developing psyche. When these patterns are influenced by sexual violence or abuse, harmful or abusive patterns can be perpetuated. 

For example an abused child may associate sexual arousal with the scenario of adult / child behaviours. As adolescent sexual feelings and desires arise, this teenager may then feel aroused in the presence of a younger child and may ‘try out’ the sexual fantasy in his head. This can give rise to the adolescent becoming the perpetrator of sexual violence or sexual abuse of other children. Early sexual abusive experience can also engender feelings of impotence – which need to be confronted by the victim becoming a dominant perpetrator, thus turning the tables in revenge on another weaker child.  

Sexual abuse         à     Victim   ß  perpetuated by further abuse 

Sexual violence      à     Associating sexual arousal with victim / child 

                à     Modification of sexual patterns 

     à     domination à sexual bully / rape  

     à     submission à masochistic patterns 

Case histories  - Sexual violence 

Tom was sexually abused by several family members and would be placed in bed with his uncles or mother and father where he would be used freely by all present. In his teens he suffered depression and paranoid feelings which later escalated to psychotic breakdowns. He was diagnosed as borderline personality disorder. In early adulthood he fathered three daughters all of whom he sexually abused. In treatment he was unable to distinguish between his abuse and himself as abuser. During his psychotic breakdowns which tended to coincide with periods of abusive activity on his part, he identified with his victims and denounced his carers as perverts and abusers.

Ellen was sexually abused by her mother. Mother would tell her how much she (Ellen) enjoyed being aroused by her and would say that this was her special gift to Ellen. Mother then became mentally ill and Ellen was taken into a children’s home. At the age of 15 Ellen became a mother herself. She would become extremely distressed when her mother telephoned and said that she would talk to her in a sexually abusive manner reminding her of what they had done together. Despite her upset, Ellen began to mistreat her baby and was thought also to be touching her sexually. Eventually her mistreatment of the child became so severe that they had to be separated for the child’s safety.

Healing Process 

We have seen how adverse childhood experiences and violence to the adolescent can cause problems in later life. It is important to also realise that there is a way forward and a chance to achieve positive change.  

The flexibility and resilience of the individual is important here but do we develop resilience by being knocked? Resilience is to an extent acquired in relation to the assaults and problems in life -  just as our bodies develops somatic strength from physical challenge, training, weight lifting etc. so our psyche develops emotional strength from learning to survive hurt and pain. Emotional development encompasses a basic necessity to learn tolerance of frustration, we can’t have everything we want.  However, in order to develop emotionally one does not need to take this to extremes, the child does not need to be abused, neglected or abandoned.  It is when this happens that the response to abuse, the survival mechanism, coping strategy, the resilience if you like,  can be maladapted - like Ellen speaking of her uncle’s abuse of her “I can take it, he can punch me as hard as he likes, I don’t feel it”.  On her sexual abuse “I didn’t think it hurt me until I stopped to think about it, I thought it was normal,  she called it just a game, it didn’t hurt me because I blanked it off”.

���Delinquency’ can be a sign of hope. In saying that I echo Winnicott’s paper of the same name and mean -rebelling, pushing out against the injustices that you have suffered in childhood - that is indeed a sign of hope - a sign that the spirit is not broken, that there is an individual in there shouting out "Hey! What about ME!" The beginnings of change, of a sense of one's own needs, of self worth.  Adolescence is regarded traditionally as a time of 'delinquency' and rebellion, a time of  change and energy - both can be channelled in the healing process and that is often what makes working with young people exciting and hopeful.