Recovery from Trauma – the Body Keeps the Score

I’m in The Hague for the next few days at the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) conference. There have been lots of interesting papers so far but I was inspired to blog about two sessions today from Bessel Van de Kolk because it’s all about the effects of trauma on the brain and how to recover from it – so exactly what I am interested in.

People’s normal response to a traumatic incident, he used the example of the twin towers attack on 9/11, is to run away and specifically run home. This is because running is a very effective strategy when you are in danger and home is a safe place.

The picture here was drawn by a 5 year old boy who was involved in 9/11. He drew this the day after, when he had escaped to his safe home. It shows the towers, falling people and at the top right a fireball. What touched me is that the black circle in the bottom of the picture is apparently a trampoline to help the people falling. It shows the inherent goodness and optimism of kids in my opinion.

But what happens when you cannot run, because you are prevented from escape? Also what happens if home is not safe? He said that in one study adults were asked if they felt safe with anyone as a child. A large percentage (didn’t write it down but I think it was around 45%) said they did not.

So this is where PTSD and other traumatic responses come in. Without the ability to escape and/or a safe person or place to help the child stays in a panic state into adulthood, which they do not have the ability to process. He describes it as being stuck with a broken alarm system – either overreacting or under reacting to events.

This panic state is either numbed emotionally, expressed explosively or dulled through behaviour that can be harmful long term (drink, drugs etc). Bessel argues that the very first thing a person who has been abused needs to learn is how to calm down in a safe, healthy way.

Apparently he asked Nelson Mandela how he stayed so calm when in prison. Mandela said it was boxing – because it helped him become aware of his body. Bessel van de Kolk recommends yoga, mindfulness, tai chi – anything involving movement and mindfulness.

Bessel has written a book about this ‘The Body Keeps the Score‘ which is very good. I realised that I had misunderstood what PTSD was. I had thought it was like on tv or the movies where a Vietnam vet is still hallucinating being in a war zone despite being at home. Instead complex PTSD can involve avoiding anything that reminds the person of their abuser(s) and can also involve using coping strategies (like drink or drugs) to reduce anxiety. ACT therapy is recommended as a useful treatment. It involves mindfulness and accepting that you will always have strong feelings about being abused and that trying to deny them actually causes problems. It’s an approach that makes sense (to me anyway).

So there’s a number of things you can try here if you are struggling:

1. Get tested for complex PTSD by your GP – The most important one I think!

2. Mindfulness

3. Tai chi

4. Martial arts

5. Yoga

6. Read any books by Russ Harris (who designed ACT therapy). They have stupid titles in my opinion but are useful books.

7. Get ‘The Body Keeps the Score’ by Bessel Van De Kolk.

 

Abusers in Positions of Power

How do abusers get access to children? Researchers have asked people who have experienced abuse and, over the years, a pretty consistent picture has emerged. On average the majority of abusers are people known to the family; neighbours, acquaintances and people in authority. The next largest group is family members, including step-family, followed by a smaller percentage of strangers. The percentages change from study to study but average around the following number ranges; acquaintances – 60-74%, family – 18-44% and strangers 11-26% (1).

There are lots of areas to discuss further, for example, gender and age differences in both perpetrator and victim, but for this blog I want to look at perpetrators who put themselves in positions of power.  One shocking study I read looked at the rates of child sexual abuse experienced by children with disabilities. Sobsey and Doe found that 96% of abused disabled children knew their abuser (2). 44% reported that their abuser was from disability support services, so the child would not have come into contact with their abuser if they did not have a disability. 

This study relates to recent articles about abuse in football, the clergy and by United Nations international aid workers. People with an interest in children are going to seek out opportunities to be with children and ways to have power over them. Obviously in many cases employees working with children are subject to criminal record checks but with the extremely low rate of abuse convictions there must be many offenders without a criminal record.

Personally I think that another approach is the education of parents and children. The website Dare2Care has good resources available. The NSPCC underwear campaign is an excellent way of teaching young children that their body belongs to them and that they can say no. I’m not suggesting it is children’s responsibility to stop abuse (abusers are responsible for abuse) but more that knowing that they can talk to someone if something makes them uncomfortable can be really useful. At the moment most abuse is not disclosed to anyone until the victim is an adult, so we need to encourage children to feel safe to speak up.

 

References (Again apologies for those articles not available online)

1)

Finkelhor, D., 1980. Risk Factors in the Sexual Victimization of Children. Child Abuse & Neglect, 4, pp.265–273.

Russell, D.E.H., 1983. The Incidence and Prevalence of Intrafamilial and Extrafamilial Sexual Abuse of Female Children. Child Abuse & Neglect, 7, pp.133–146.

Finkelhor, D. et al., 2014. The lifetime prevalence of child sexual abuse and sexual assault assessed in late adolescence. Journal of Adolescent Health, 55(3), pp.329–333. Available at: http://dx.doi.org/10.1016/j.jadohealth.2013.12.026.

2)

Sobsey, D. & Doe, T., 1991. Patterns of sexual abuse and assault. Sexuality and Disability, 9 (3), pp.243–259.

Teenagers and Consent

There’s been a lot in the news lately about the Criminal Injuries Compensation Authority (CICA) denying compensation to victims of child sexual abuse (CSA) on the grounds that they consented. I wonder how many of these were teenagers because we do really seem to have a problem addressing CSA when teenagers are the victims.

There is a long history of this. Before the Victorian era the age of consent was generally set at the onset of puberty (between 10-12 years old) however children were engaged and married earlier, especially in the upper classes (1). In 1885 a new law was proposed to raise the age of consent to 16, for girls, to enable prosecution of people exploiting younger teenagers. However many MPs were opposed. Here’s a quote from Charles Hopwood, MP.

‘these girls who went wrong from an early age were just as familiar with the result of their actions as those of an older age. [“No!”] It was all very well to cry “No!” but those Members who did so were judging by their own families, who were carefully nurtured and preserved from contamination; but girls who went upon the streets came from a different class.’ (2)

So this isn’t just about the age of the victims but also class. Eventually the law was passed, thanks to a press campaign, but the exploitation of teenagers continued. In 1989 Wild (3) studied ‘child sex rings’ in Leeds and found 334 child victims in 31 cases with nine having a commercial basis. Thus we have child sexual exploitation (CSE) identified back in the 1980’s. I’m not sure what was done about this, if anything.

Now we have another opportunity to tackle CSE. I’d argue that the first step is to agree that a child cannot consent to sexual exploitation. Finkelhor (4) says that for:

‘true consent to occur, two conditions must prevail. A person must know what it is that he or she is consenting to, and a person must be free to say yes or no… children lack the information that is necessary to make an “informed” decision about the matter. They are ignorant about sex and sexual relationships…children have a hard time saying no to adults.’

Can we just agree this point, embed it in our government agencies and get on with sorting the actual issue out, rather than blaming the victims?

 

REFERENCES (apologies that these are not all available online)

  1. Ingram, M., (1987). Church Courts, Sex and Marriage in England, 1570-1640, Cambridge: Cambridge University Press.
  2. Hansard, (1885). Commons Sitting of Friday, 31st July, 1885., London. Available here: http://hansard.millbanksystems.com/commons/1885/jul/31/criminal-law-amendment-bill-lords-bill
  3. Wild, N.J., (1989). Prevalence of Child Sex Rings. Pediatrics, 83(4), p.553.
  4. Finkelhor, D., (1979). What’s wrong with sex between adults and children? Ethics and the problem of sexual abuse. American Journal of Orthopsychiatry, 49(4), pp.692–697.

 

 

 

 

 

It’s not just about counselling

away-1040726_1920My research is looking at recovery from childhood sexual abuse (CSA). As a survivor I think that recovery is about much more than counselling, it’s about how we relate to others, how we explain life, how we see ourselves, how we express ourselves – and much more. You might have a different opinion. I’ve got a survey prepared that aims to understand how other survivors and victims see recovery. It’s going through ethics approval at the University of Sheffield at the moment and once it’s ready I’ll post the link on here.

In the meantime I’ve created this website as my space to post about my research and CSA issues in general. One of the things I’d like to do is write about the research that has been carried out already and what it tells us about victims and perpetrators. So my next post will be about that.