Modern history of child sexual abuse awareness: cycles of discovery and suppression.

In the last century and a half, public and professional awareness of sexual abuse has emerged and been suppressed repeatedly. The 20th-century suppression of the problem has been linked to Freudianism, sexual modernism, and gender politics. Recent awareness of sexual abuse differs from awareness in the past because of the significant amount of current research attesting to the prevalence of sexual abuse and its injurious impact on human development. However, in the contemporary mental health professions, the courts, and the media, there has emerged an influential backlash against the latest discovery of child sexual victimization that utilizes arguments employed during earlier periods of suppression. Knowledge of the earlier cycles of discovery and suppression can assist professionals in understanding and countering present attempts to deny or minimize the problem of child sexual abuse.

The centrality of victimization. Regaining the focal point of recovery for survivors of child sexual abuse.

Psychiatrists have tended to be reluctant followers rather than leaders in the proliferation of concern for child abuse that has developed over the past 25 years. By discounting the relevance of child sexual trauma, psychiatric clinicians and theoreticians overlook not only the therapeutic needs of many survivors but the opportunity to reconceptualize the role of trauma in the etiology and treatment of conditions presumed to be incurable. Present controversies over child sexual abuse are mirrors of past misadventures with uncovering. Since 1860, child abuse has been discovered and then discredited every 35 years by the most visionary clinicians of the day, each faced with the alternative of denouncing the discovery or succumbing to scorn and disgrace. The history of child sexual abuse, whether viewed by parent via child, therapist via patient, or adult survivor via the child within, is one of unimaginable pain and betrayal masked by adult distancing, disavowal, victim blame, and identification with the aggressor. The lurid emotional imperatives of the trauma itself have no place in a just and fair society, and they resist translation into the rational, objective language and concepts of behavioral science. The subject of child sexual abuse is itself so passionate and so paradoxical that it provokes polarized dichotomies at every level, leaving indifference and avoidance as the only hope for serenity. The active nesciance, the determined insistence on not knowing, that pervades every aspect of child sexual abuse encourages the most authoritative scholars to be the most repressive of radical discovery, especially if authority has been achieved as a reaction against youthful vulnerability. Every clinician facing a survivor of childhood sexual trauma faces an assault on personal comfort and authority, just as each patient in that encounter risks intimidation and disgrace. The connections between childhood assault and adult adjustment will be missed unless the therapist can find an unprejudiced path toward mutual acceptance. The promise of genuine understanding and radical resolution of the effects of child sexual abuse is dimmed on both sides by a history of abandonment in the face of scornful, punishing authority. Freud's concept of the unconscious as the arena for successful psychotherapy, his sense of the patient as a normal, healthy individual incapacitated by the effects of buried trauma and his initial optimism for radical recovery from post-traumatic handicaps were soundly derived from his clinical confrontations with child sexual abuse, as were Ferenczi's parallel contributions 35 years later.(ABSTRACT TRUNCATED AT 400 WORDS)

The child sexual abuse accommodation syndrome.

Child victims of sexual abuse face secondary trauma in the crisis of discovery. Their attempts to reconcile their private experiences with the realities of the outer world are assaulted by the disbelief, blame and rejection they experience from adults. The normal coping behavior of the child contradicts the entrenched beliefs and expectations typically held by adults, stigmatizing the child with charges of lying, manipulating or imagining from parents, courts and clinicians. Such abandonment by the very adults most crucial to the child's protection and recovery drives the child deeper into self-blame, self-hate, alienation and revictimization. In contrast, the advocacy of an empathic clinician within a supportive treatment network can provide vital credibility and endorsement for the child. Evaluation of the responses of normal children to sexual assault provides clear evidence that societal definitions of "normal" victim behavior are inappropriate and procrustean, serving adults as mythic insulators against the child's pain. Within this climate of prejudice, the sequential survival options available to the victim further alienate the child from any hope of outside credibility or acceptance. Ironically, the child's inevitable choice of the "wrong" options reinforces and perpetuates the prejudicial myths. The most typical reactions of children are classified in this paper as the child sexual abuse accommodation syndrome. The syndrome is composed of five categories, of which two define basic childhood vulnerability and three are sequentially contingent on sexual assault: (1) secrecy, (2) helplessness, (3) entrapment and accommodation, (4) delayed, unconvincing disclosure, and (5) retraction. The accommodation syndrome is proposed as a simple and logical model for use by clinicians to improve understanding and acceptance of the child's position in the complex and controversial dynamics of sexual victimization. Application of the syndrome tends to challenge entrenched myths and prejudice, providing credibility and advocacy for the child within the home, the courts, and throughout the treatment process. The paper also provides discussion of the child's coping strategies as analogs for subsequent behavioral and psychological problems, including implications for specific modalities of treatment.