Sexual abuse: Silence, shame, pain
"Every night he would enter my room. I did not enjoy it. It was sheer horror. He threatened me. I could tell no one. I was angry, hurt and humiliated. I felt powerless. He threatened me. I could tell no one. I found release from my pain in cutting myself. I endured this for years. My life was completely shattered. I suffered for years. My stepfather sexually abused me."
This is the voice of a woman who experienced prolonged, repeated sexual abuse as a child. Every day I, as a mental-health professional, become more aware of the extent of this problem. There are many women and men who are survivors of childhood sexual abuse.
Powerlessness and violation
Sexual abuse has a profound psychological impact. Most people who experience abuse develop a sense of powerlessness and helplessness. They live with the terrible feeling that their body was invaded, defiled and violated. This results in poor self-esteem and a sense of humiliation.
Secrecy and silence
Victims often live in a world of silence, secrecy, shame and pain. They are silenced through threats and bottle up their pain and suffering for years. This may result in anxiety, depression, fear and out-of-body experiences. Some people constantly report physical symptoms such as back pain.
Prevented from speaking about their pain, many individuals engage in self-mutilating beha-viours such as 'cutting' in order to relive the psychological pain and gain attention. Others sometimes make repeated suicidal gestures such as overdosing on drugs.
Many people also report intense feelings of guilt and shame. Survivors have to be reminded that they did nothing wrong; it is the adults in their lives who failed to protect them.
Post-traumatic stress disorder
Survivors of sexual abuse develop symptoms of post-traumatic stress disorder. They constantly re-live the trauma and are tormented by the memory, images and thoughts of the trauma. This may result in constant nightmares. It is not uncommon for some people to bury the pain by actually suppressing all memories of the abuse. Others disconnect themselves from the pain and may have out-of-body experiences or assume various personalities to deal with it.
Retraumatising the victim
Many children who were sexual abused are caught up in a cycle of abuse in which they are constantly re-traumatised. They are constantly forced to retell their traumatic experiences. All our systems - health, education, police, the courts and social services - do not sufficiently handle children who are sexually abused with sensitivity and care. In addition, some children are placed in the care of the state and are further abused. As adults, survivors of sexual abuse often end up in unhealthy relationships in which they are further exposed to abuse.
Seek professional help
People who have experienced prolonged and repeated abuse need long-term therapy. Therapy will help in several ways:
1. It helps the individual to tell their story in a non-judgemental space where there will be acknowledgement of the injustice done. They will also get the opportunity to work through their psychological pain.
2. It will bring relief from such symptoms as depression and anxiety. Medication may be necessary at times.
3. It helps them to go grieve, mourn and deal with the profound sense of loss experienced.
4. It helps survivors to reintegrate and reconstruct their shattered lives and sense of self.
5. It helps survivors to develop trusting relationships so that they can go on to lead healthy and stable lives.
Dr Wendel Abel is a consultant psychiatrist and head, Section of Psychiatry, Dept Of Community Health and Psychiatry, University of the West Indies, 977-1108; email: firstname.lastname@example.org.
Survivors of sexual abuse developsymptoms of post-traumatic stress disorder. They constantly relive the trauma and are tormented by the memory, images and thoughts of the trauma.