Child victims of sexual abuse: how to break the silence?

The phenomenon of “dissociation”, which can also occur with other types of trauma, is one of the keys to understanding the “traumatic amnesia” experienced by many victims of sexual abuse who are unable to speak. This reaction of physiological survival occurs when the violence is overwhelming (and can even cause a “stress-induced death”), paralysing higher mental functions and completely cutting off the emotional response. The person feels as if they are “beside” or “above” their body. Its counterpart, known as traumatic memory, can bring past events buried in the subconscious to the surface at any time. Assaults frequently return in the form of flashbacks, in adulthood, and can be triggered by an odour, a place or a colour that reawakens old traumas. On top of these physiological reactions is the hierarchical and relational context surrounding these cases of abuse. As between 70% and 85% of children know their abuser, victims can find it even harder to speak out.

INCEST: SILENCE AND DENIAL

“The family is the main sphere in which sexual abuse and violence takes place. Incest often occurs within a special relationship between an abusive adult and a child,” says Alessandra Duc Marwood, psychiatrist and senior physician at Les Boréales, a counselling centre created in 2010 to address issues of domestic violence. “Children are victims of violence at the hand of figures who represent protection and security. This causes confusion about the individual who is supposed to protect and provide love but in fact does them harm. We learn the rules about how relationships work within our family. How can they know what’s normal and what’s not?” the psychiatrist says. This point is also highlighted by French journalist Charlotte Pudlowski in her painstaking investigation based on a real-life family experience, Ou peut-être une nuit – Inceste : la guerre du silence (Or maybe one night – Incest: the war of silence)1. “We don’t rebel against people we love. That’s what makes incest such a powerful weapon of domination.” 

Racked with shame and guilt, young victims remain agonisingly silent when they know that opening up about a situation of abuse committed by someone close to them means jeopardising the “tight-knit” family unit. “In families where incestuous acts exist, words are more punishable than actions,” Alessandra Duc Marwood says. In her essay, Charlotte Pudlowski also writes, “The more the person feels love and respect, with a sense of indebtedness and dependency, the greater the risk of obliterating their foundation, loved ones and family, and the more impossible it becomes to rebel. Accusation seems unmanageable, or cannot be right away, or will be too late, or come at the cost of being excluded from the home.” This wall was faced by Marjorie, 34, who was abused by her cousin from the age of 4 to 10: “He used to shut me up, telling me that it was dirty, and that if I told anyone, everyone would think I was dirty too. I once tried to tell my grandmother, but she didn’t react.” Denial from spouses and relatives is common with cases of incest. They often go so far as taking the perpetrator’s side, the psychiatrist says. Heidi experienced this disavowal from her mother, when her mother found out that her own husband had abused her daughter for years. “At first, she was sorry, but then she blamed me, accusing me of having purposely seduced my stepfather,” the 22-year-old student says. She has since cut off any ties with her mother. 

^{1 "}Éd. Grasset, 2021"

Aggressors are also frequently in denial, Alessandra Duc Marwood says. “Many perpetrators of violence confess to the acts but deny any responsibility. We need to remind them that a child never consents to or asks for sexual favours.” Professionals then need to work carefully with the abuser to get them to acknowledge the facts, reminding them of the law and, more importantly, helping them to realise the impact of incest. 

A matter of public health

While the number of cases of sexual violence on minors remains underestimated, their repercussions on public health are quite tangible. A 2018 study in the United States² estimated that child sexual abuse cost the country more than $9 billion in economic losses. This figure covers healthcare, child welfare services, special education, violence, crime, suicide and productivity losses of the abused. “We’re not created equally when it comes to risk or resilience. But we do know that having experienced violence or abuse has a negative impact on the future,” says Alessandra Duc Marwood. The ramifications are even worse if risk factors are compounded (social isolation, illness, poverty, etc.). 

The damage that children come away with varies with individuals and their gender. It may take the form of shock, anxiety, aggression, developmental delays or neurobiological manifestations. The after-effects often last into adulthood and future generations, which is even more likely if the abuse is repeated. It can result in attachment problems, OCD, aggression, addictions, risky sexual behaviour, chronic illness, social isolation, and the list goes on. For Marjorie, the abuse perpetrated by her cousin resulted in bouts with anorexia and bulimia, problem drinking and difficulties with intimacy. “To this day, I still use pretty childish expressions to talk about sex, or I simply try to avoid talking about it. I always feel like I’m doing something wrong or dirty,” the young woman says, and her hang-ups have ruined many of her relationships. As for Heidi, she remembers having her first period very early, at the age of 9. “As a child, I was already dressing as if I was older. I would wear lipstick. My stepfather used to buy me grown-up clothes.” She, too, struggles with her sexuality and suffers from flashbacks. 

Less well known consequences are cardiovascular problems in adulthood that may also stem from trauma, including sexual abuse. “Regardless of the type of mistreatment, a victim of abuse is more likely to be in a constant state of hypervigilance due to post-traumatic stress disorder and live with continuously high levels of adrenaline and cortisol,” says Marco Tuberoso, psychologist at Espas, an organisation that works with child and adult victims of sexual abuse. The essay “Ou peut-être une nuit” (Or maybe one night) tells the story of Lydia, 48, who developed a degenerative neurovegetative disease following repeated psychological trauma due to sexual abuse by her father. She is now in a wheelchair. 

“Suffering sexual assault doesn’t always mean a bad prognosis for the child’s future development,” Francesca Hoegger says. “But finding the necessary support helps them to get better. The earlier the child is taken into care, the less the abuse is likely to impact their future health.” Alessandra Duc Marwood treads more lightly, acknowledging that “many former victims build a life for themselves and go on to do wonderful things. But at the cost of tremendous suffering.”

² «One Year’s Losses for Child Sexual Abuse in U.S. Top $9 Billion, New Study Suggests» | Johns Hopkins | Bloomberg School of Public Health (jhu.edu)

Help for adults concerned about

Sometimes society is more comfortable healing wounds than preventing them. It can feel easier to take care of victims rather than asking who their aggressors are, why they act, and how such violence, decade after decade, can eat away at our societies in total impunity. That way, we avoid staring straight into the face of the people we know who have committed the unspeakable. Some organisations have boldly set out to get to the root of the problem, such as Dis No, an organisation discreetly operating out of the second floor of a residential building in the centre of Lausanne. 

The mission of this organisation, the only one of its kind in French-speaking Switzerland, is to help teens and adults concerned about their sexual fantasies about children (commonly referred to as “paedophilia”) and who risk acting on these urges. The problem affects approximately 1% of the male population (i.e. around 66,000 people in Switzerland), with “considerable stigma and taboo” surrounding it, says Hakim Gonthier, the organisation’s director. “We work with people feeling immense distress, who don’t know where else to turn. How should they talk to their loved ones? We are often the only people who know what’s going on in their heads.” 

The organisation offers them and their loved ones an attentive ear and supports them through a process of change that can take time. “We frequently observe that they tend to minimise the facts, through denial and cognitive distortions, i.e. they interpret children’s actions as an invitation. We help them to become aware of these fantasies, redefine them and explain what the laws are,” Hakim Gonthier says. However, the director offers some hope. “Taking the step of contacting us can protect them from acting on their impulses.” Dis No does not provide any sort of therapy but can refer people to experts if they are willing to go. However, therapists can be hard to find. They are often untrained or reluctant to work with these patients. 

As with perpetrators of sexual abuse, the majority of people who come to the organisation are men. Women who seek help from Dis No more typically suffer from paedophilia OCD – the “fear of being a paedophile” – as opposed to actually being attracted to children. The organisation is determined in its fight against the myths surrounding this disorder and reminds us that paedophilia is not the same as sexual assault. “Only 30% to 40% of people who have sexually assaulted children are estimated to have a primary or exclusive sexual attraction to children, which would classify them as paedophiles,” Hakim Gonthier says. “The remaining 60% do not fit with a paedophilia diagnosis but are opportunistic aggressors with a psychopath or antisocial profile.” He also recommends not stigmatising this attraction, as long as it is delimited within clear-cut boundaries and non-acting strategies and remains restricted to thoughts. “Contact someone before the situation gets out of hand. The shockwave is too intense for the victim, the person and their loved ones. Once the line has been crossed, there’s no turning back,” he says.
 

Marco Tuberoso from Espas works with perpetrators under age 18 referred by the juvenile court. The majority are boys, most of whom have also suffered abuse, and a third are victims of sexual violence. “However, this does not mean that all abuse victims become abusers,” Marco Tuberoso says. “For teenage perpetrators, sexuality is often a way of turning to a pattern of delinquency, showing just how bad they are doing.” In a gendered society where emotional expression is still excluded from the construct of masculinity (girls, on the other hand, are more likely to have self-destructive tendencies), the psychologist focuses on getting these young men to talk about what they are going through, while reminding them that having been abused does not entitle them to go out and attack someone else.
 

Re-educating society

Sexual violence is rooted in every stratum of a patriarchal society. No one, victim or loved one, is spared. It even impacts subsequent generations and must be understood as a matter of public health. Turning a blind eye or remaining silent to keep up good appearances of family and social relationships is punishable by law. This is also true for healthcare professionals. Those we interviewed feel that they still receive far too little training on these problems but nevertheless end up having to deal with the resulting tragedies. “We must dare to ask the question, open the door and let them in,” insists Francesca Hoegger. And Alessandra Duc Marwood concludes, “We need to re-educate society. We have a duty to listen to and protect the most vulnerable.”