In some instances, even when crisis intervention has been intensive and appropriate, the mother and daughter are already so deeply estranged at the time of disclosure that the bond between them seems irreparable. In this situation, no useful purpose is served by trying to separate the mother and father and keep the daughter at home. The daughter has already been emotionally expelled from her family; removing her to protective custody is simply the concrete expression of the family reality.These are the cases which many agencies call their “tragedies.” This report of a child protective worker illustrates a case where removing the child from the home was the only reasonable course of action:Division of Family and Children’s Services received an anonymous telephone call on Sept. 14 from a man who stated that heoverheard Tracy W., age 8, of [address] tell his daughter of a forced oral-genital assault, allegedly perpetrated against this child by her mother’s boyfriend, one Raymond S.Two workers visited the W. home on Sept. 17. According to their report, Mrs. W. was heavily under the influence of alcohol at the time of the visit. Mrs. W. stated immediately that she was aware why the two workers wanted to see her, because Mr. S. had “hurt her little girl.” In the course of the interview, Mrs. W. acknowledged and described how Mr. S. had forced Tracy to have relations with him. Workers then interviewed Tracy and she verified what mother had stated. According to Mrs. W., Mr. S. admitted the sexual assault, claiming that he was drunk and not accountable for his actions. Mother then stated to workers that she banished Mr. S. from her home.I had my first contact with mother and child at their home on Sept. 20 and I subsequently saw this family once a week. Mother was usually intoxicated and drinking beer when I saw her. I met Mr. S. on my second visit. Mr. S. denied having had any sexual relations with Tracy. Mother explained that she had obtained a license and planned to marry Mr. S.On my third visit, Mrs. W. was again intoxicated and drinking despite my previous request that she not drink during my visit. Mother explained that Mr. S. had taken off to another state and she never wanted to see him again. On this visit mother demanded that Tracy tell me the details of her sexual involvement with Mr. S. On my fourth visit, Mr. S. and Mrs. S. were present. Mother explained that they had been married the previous Saturday. On my fifth visit, Mr. S. was not present. During our discussion, mother commented that “Bay was not the ﬁrst one who hadTracy.” After exploring this statement with mother and Tracy, it became clear that Tracy had been sexually exploited in the same manner at age six by another of Mrs. S.'s previous boyfriends.On my sixth visit, Mrs. S. stated that she could accept Tracy’s being placed with another family as long as it did not appear to Tracy that it was her mother’s decision to give her up. Mother also commented, “I wish the fuck I never had her.”It appears that Mrs. S. has had a number of other children all of whom have lived with other relatives or were in foster care for part of their lives. Tracy herself lived with a paternal aunt from birth to age ﬁve.
While in principle groups for survivors are a good idea, in practice it soon becomes apparent that to organize a successful group is no simple matter. Groups that start out with hope and promise can dissolve acrimoniously, causing pain and disappointment to all involved. The destructive potential of groups is equal to their therapeutic promise. The role of the group leader carries with it a risk of the irresponsible exercise of authority.Conflicts that erupt among group members can all too easily re-create the dynamics of the traumatic event, with group members assuming the roles of perpetrator, accomplice, bystander, victim, and rescuer. Such conflicts can be hurtful to individual participants and can lead to the group’s demise. In order to be successful, a group must have a clear and focused understanding of its therapeutic task and a structure that protects all participants adequately against the dangers of traumatic reenactment. Though groups may vary widely in composition and structure, these basic conditions must be fulfilled without exception.Commonality with other people carries with it all the meanings of the word common. It means belonging to a society, having a public role, being part of that which is universal. It means having a feeling of familiarity, of being known, of communion. It means taking part in the customary, the commonplace, the ordinary, and the everyday. It also carries with it a feeling of smallness, or insignificance, a sense that one’s own troubles are ‘as a drop of rain in the sea.’ The survivor who has achieved commonality with others can rest from her labors. Her recovery is accomplished; all that remains before her is her life.
HYPERAROUSALAfter a traumatic experience, the human system of self-preservation seems to go onto permanent alert, as if the danger might return at any moment. Physiological arousal continues unabated. In this state of hyerarousal, which is the first cardinal symptom of post-traumatic stress disorder, the traumatized person startles easily, reacts irritably to small provocations, and sleeps poorly. Kardiner propsed that "the nucleus of the [traumatic] neurosis is physioneurosis."8 He believed that many of the symptoms observed in combat veterans of the First World War-startle reactions, hyperalertness, vigilance for the return of danger, nightmares, and psychosomatic complaints-could be understood as resulting from chronic arousal of the autonomic nervous system. He also interpreted the irritability and explosively aggressive behavior of traumatized men as disorganized fragments of a shattered "fight or flight" response to overwhelming danger.
Since most sexual abuse begins well before puberty, preventive education, if it is to have any effect at all, should begin early in grade school. Ideally, information on sexual abuse should be integrated into a general curriculum of sex education. In those communities where the experiment has been tried, it has been shown conclusively that children can learnwhat they most need to know about sexual abuse, without becoming unduly frightened or developing generally negative sexual attitudes. In Minneapolis, Minnesota, for example, the Hennepin County Attorney's office developed an education program on sexual assault for elementary school children. The program was presented to all age groups in four different schools, some eight hundred children in all. The presentation opened with a performance by a children’s theater group, illustrating thedifference between affectionate touching, and exploitative touching. The children’s responses to the skits indicated that they understood the distinction very well indeed. Following the presentation, about one child in six disclosed a sexual experience with an adult, ranging from an encounter with an exhibitionist to involvement in incest. Most of the children,both boys and girls, had not told anyone prior to the classroom discussion. In addition to basic information on sexual relations and sexual assault, children need to know that they have the right to their own bodily integity.
The only one of the early investigators who carried the exploration of hysteria to its logical conclusion was Breuer's patient Anna O. After Breuer abandoned her, she apparently remained ill for several years. And then she recovered. The mute hysteric who had invented the "talking cure" found her voice and her sanity, in the women's liberation movement. Under a pseudonym, Paul Berthold, she translated into German the classic treatise by Mary Wollstonecraft, A Vindication of the Rights of Women, and authored a play, Women's Rights. Under her own name, Bertha Papenheim became a prominent feminist social worker, intellectual, and organizer. In the course of a long and fruitful career she directed an orphanage for girls, founded a feminist organization for Jewish women and traveled throughout Europe and the Middle East to campaign against the sexual exploitation of women and children. Her dedication, energy and commitment were legendary. In the words of a colleague, 'A volcano lived in this woman... Her fight against the abuse of women and children was almost a physically felt pain for her.' At her death, the philosopher Martin Buber commemorated her: 'I not only admired her but loved her, and will love her until the day I die. There are people of spirit and there are people of passion, both less common than one might think. Rarer still are the people of spirit and passion. But rarest of all is a passionate spirit. Bertha Pappenheim was a woman with just such a spirit.
Recovery can take place only within then context of relationships; it cannot occur in isolation. In her renewed connection with other people, the survivor re-creates the psychological facilities that were damaged or deformed by the traumatic experience. These faculties include the basic operations of trust, autonomy, initiative, competence, identity, and intimacy.Just as these capabilities are formed in relationships with other people, they must be reformed in such relationships.The first principle of recovery is empowerment of the survivor. She must be the author and arbiter of her own recovery. Others may offer advice, support, assistance, affection, and care, but not cure.Many benevolent and well-intentioned attempts to assist the survivor founder because this basic principle of empowerment is not observed. No intervention that takes power away from the survivor can possibly foster her recovery, no matter how much it appears to be in her immediate best interest.