On excuses, reasons, and choice

I met someone some time ago who had some personality features I didn’t quite like. We were close for a time and so I told her that some of the things she did bothered and sometimes even hurt me. She told me that it was all because that’s just how she was, that that’s how she had turned out after been raped as a teenager by her father. Of course, that is a terrible thing to happen to anyone and I know it takes a lot of courage to tell your own story. And, of course, I also realise that childhood sexual abuse really does mess you up in so many ways! The strangeness of this particular situation was that this friend said to me fairly often “that’s just how I am” and reminded me about her father. I knew; I wasn’t going to forget what she had told me – it was something deeply serious! However, after so many times that she told me that that’s how she is and it’s due to the childhood sexual abuse she had suffered, I remembered that she wasn’t the only person this had happened to. Don’t get me wrong, it’s a very sad and disturbing thing and every single person this happens to will experience it differently and will be affected differently by it in the long-term. However, I felt that with me she was using it as an excuse for her behaviour so as to avoid apology, or – God forbid – change.

I have known a very many people who have been sexually abused as children and not everyone was as mean as this ‘friend’ was to me; they weren’t obligated to be mean by reason of their terrible experiences. When I remembered this, and at the last straw with this friend, I walked away from it all. Yes, I know that people with histories of abuse in childhood are more likely to have a personality disorder in adulthood than those who never had those experiences. And yet I also believe in the human potential for change. I know that you can take away every choice from a child when he is abused. I also know that at some point a child becomes and adult and all adults have the choice to continue to be victims to the past or to progress from there. It’s a choice. My friend wasn’t without awareness of how her personality and the things she said and did hurt others (myself included), and she was a very smart woman academically and creatively. When I told her that something she did or said hurt me, she didn’t say “I’m sorry. I will try not to do it again”. No, she would say, “that’s just how I am. You know with what my dad did to me”. Yes, I knew that. I also knew he wasn’t currently doing that her; she was no longer a victim, she was just choosing to continue to wear the victim cloak as an excuse not to alter her adult behaviour. Finally, it hurt me too much to continue to be her friend when she found it easier to say “this is how I am” than to alter her behaviour to prevent hurting those that were simply trying to be a good friend to her.

On the dobber's (/victim's) dilemma

I have previously mentioned the difficulty faced by victims of childhood sexual abuse as children and adolescents in telling someone of their predicament. They hesitate due to embarrassment, unwarranted guilt, fear, lack of understanding that they are victims to a terrible sin, and being unaware of the process, etc. Recently I’ve encountered a similar scenario, but in the adult victims of past sexual abuse.

Victims of childhood sexual abuse eventually grow up to become adults. Some become very capable adults, and a lot become crippled by the emotional and psychological scars of trauma. A lot of the people we encounter on a day to day basis have been past victims of this worst of crimes, most have never told a soul of their experiences. I want now to discuss a composite of this person, let’s call her Elisabeth.

An Unpleasant Story 

Elizabeth was sexually abused by Josef between the ages of 10 and 14. Josef was Elisabeth’s stepfather, who joined the family just before Elisabeth’s 10^th birthday. Elisabeth told Rosemarie, her mother, of Josef’s behaviour towards her, the fondling, etc. She did this when she was 14 and then the abuse stopped. Rosemarie had some “stern” words with Josef, but eventually she was a woman in love and they decided to put this “episode” behind them and move forward with family life. The “episode” was never discussed with police or counsellors or anyone else who may have cared. Rosemarie and Josef remain together to this day. Elisabeth, somehow, finally managed to escape the rape dungeon she called a home.

Elisabeth became a woman of her own, independent, self-sufficient, struggled with some things but succeeded in others; she was just a normal woman with a past most of us would never wish on our worst enemies. But the past was in the past and the past can’t hurt you, right? I don’t know that that is right. Elisabeth had managed to move ahead with her life, leaving the past behind, until one day the past came back to find her. Sounds clichéd, right? Yes, but it also sounds horrible and unfair.

One day Elisabeth found out that Josef was accused of doing some things she knew he was capable of, things she had witnessed at one time when she had been the victim of such things. But this was a separate incident, separate incidentS, things not related to her at all, but it brought to her consciousness something that she had suspected all along: that she was not Josef’s only ever victim. There had been others, there probably would be more… And whenever we read this scenario the answer seems so simple: tell. Elisabeth should tell her story, right? Elisabeth should do the right thing for the greater good, right?

Imagine yourself in Elisabeth’s shoes. In the movies and episodes of Law & Order: SVU what happens is that the Elisabeth-character tells her story, feels good about herself, saves the day, the baddie goes to prison forever, and everyone has a perfect life thereafter. Reality is not like the movies. Elisabeth knows this.

Elisabeth asks some people for advice; should she “assist” the potential case against Josef? This isn’t about her life or the things that happened to her, this is about doing the allegedly right thing. Everyone tells her, ‘yes, of course, you HAVE to tell your story’, it’s her duty. The thing is Elisabeth has a life now. She has left that past behind and she owes no-one anything for getting where she is. Who does she owe? Josef’s other victims? The “general public”? Why? She suffered too, but how does that make her anything other than a victim? And will she really feel better to tell her story, to become the hero that saves the fate of children she’s never met and owes nothing to? Doing good things makes everyone feel good, we’re told… And yet I feel that no one should feel coerced to re-live any pain except for their own self.

How do we convince Elisabeth to do the “right” thing? What is the right thing to do? This is the dilemma of knowing something that incriminates someone, but that also inadvertedly incriminates you too. I know you’re thinking ‘but how does that incriminate her if she tells her story?’ Josef maybe or maybe doesn’t get prison time. Elisabeth is punished by having to re-live pain of her story, the humiliation and embarrassment of discussing the very personal and degrading things done to her, she is faced by the well-meaning but hurtful murmurs that if she had told earlier none of those other victims should have had to suffer what they did. Is it worth it? Is the sacrifice worth it for Elisabeth? Forget for a second the “general public”, the “greater good”, is all this worth it to Elisabeth? What will she gain by telling her story?... It’s easy to answer that, but not if you’re truly only thinking of Elisabeth. The only person thinking of Elisabeth – and for a long time – has only being Elisabeth.

And if Elisabeth doesn’t tell her story and Josef goes on to abuse other children, is it Elisabeth’s fault or is it Josef’s? Elisabeth was a victim. Before we judge her, we have to understand her dilemma. Sometimes it’s enough to be a survivor without being a hero.

On the Eminem thing

People think I’m trying to be purposely funny when I describe myself in the “About Me” section as being like Eminem. I’ll be the first to admit I’ve never met Marshall Mathers III, and I’ve never even had the good fortune of being to an Eminem concert. I identify a lot with most of the lyrics of Eminem’s songs, though. A lot of people must; he sells records in the millions of copies. Personally I believe he is a great expressionist, and not only that, he has a very common human story.

There is an Eminem song (Same song & dance) where he is considering different ways to tell his crush how he feels about her (he’s a shy, socially-awkward person like so many of us) and he postulates: "Should I cut off one of my ears and mail it to her? Send her pictures of my collections of skeletons? Or footage of me impaling myself on an elephant's tusk?" This kind of strategy may not occur to everyone, but it does to Eminem because he is he and he thinks the way he does… I keep a small collection of animal skeletons and to me Eminem’s proposition of sharing something dear to him does not seem strange.

I won’t go try to analyse Eminem’s lyrics for anyone, but I would like to share some of them which are the reason I identify with him so much. I guess, the way Jorge Luis Borge’s words always come to mind: ‘each man is every man’ and each man’s story is shared by every man. I have been the “dark phase” Eminem, as much as I have been the Eminem who rejoices in his blessings. We all have to different degrees, I think J

I'm not afraid /To take a stand

Everybody /Come take my hand

We'll walk this road together, through the storm

Whatever weather, cold or warm

Just lettin’ you know that you're not alone

Holla if you feel like you've been down the same road…

****

I got some skeletons in my closet /and I don't know if no one knows it /So before they thrown me inside my coffin and close it /I'm-a expose it... (Cleaning Out my Closet)

Well since age twelve, I've felt like I'm someone else /’Cause I hung my original self from the top bunk with a belt...

And by the way, when you see my dad, /Tell him that I slit his throat in this dream I had. (My Name is)

All I know is I don't want to follow in the footsteps of my dad /’cause I hate him so bad /The worst fear that I had /was growing up to be like his f*ckin’ ass /Man if you could understand /why I am the way that I am... I never dreamt I'd get to the level that I'm at /This is whack! This is more than I ever could have asked... (Saying Goodbye to Hollywood)

Yo, never was a thug, just infatuated with guns...

/I'm a soldier, these shoulders hold up so much /They won't budge, I'll never fall or fold up... (Soldier)

My thoughts are sporadic /I act like I'm an addict /I rap like I'm addicted to smack... (‘Til I Collapse)

Sometimes I feel so alone /I just don't know /feels like I been down this road before /So lonely and cold /it's like something takes over me /Soon as I go home and close the door. (Deja Vu)

I'm just so f*ckin' depressed /I just can seem to get out this slump... I think I'm starting to lose my sense of humour /Everything is so tense and gloom... (Beautiful)

Sometimes I even cut myself to see how much it bleeds /It's like adrenaline, the pain is such a sudden rush for me...

But what's this sh*t you said about you like to cut your wrists too? /I say that sh*t just clownin’, dog /C'mon, how f*cked up is you? /You got some issues, Stan. I think you need some counselling... (Stan)

If I, were to die murdered in cold blood tomorrow /Would you feel sorrow or show love, or would it matter?...

But there's way too much at stake for me to be fake /There's too much on my plate, I’ve come way /too far in this game to turn and walk away...

The only way I'm leavin’ this bitch is suicide... I'm not what ya think /I appear to be f*cked up, mentally endangered /I can't stay away from a razor...

 It hurts when you see your friends turn their back on you, dog /And you ain't got nothing’ left but your word and your balls /And you're stressed from the calls of your new friends /Begging with their hands out...

Death itself can hurt me /Just the thought of dyin’ alone that really irks me (When the Music Stops)

Sometimes I think, there's nothing to live for /I almost break down and cry /Sometimes I think I'm crazy; I'm crazy, oh so crazy! /Why am I here? Am I just wastin’ my time?..

People make jokes, cos they don't understand me /They just don't see my real side /I act like shit don't phase me /Inside it drives me crazy /My insecurities could eat me alive... Sometimes it feels like the world's on my shoulders /Everyone's leanin’ on me /Sometimes it feels like the world's almost over... (Hailie’s Song)

I never would have dreamed in a million years I'd see /so many motherf*ckin’ people, who feel like me /Who share the same views and the same exact beliefs /It's like a f*ckin ARMY marching in back of me (White America)

Yet everybody just feels like they can relate /I guess words are a motherf*cker, they can be great /or they can degrade. Or even worse, they can teach hate /It's like these kids hang on every single statement we make /like they worship us... They say music can alter moods and talk to you /Well can it load a gun up for you and cock it too?... That's why we sing for these kids who don't have a thing /except for a dream and a f*ckin’ rap magazine /Who post pin-up pictures on they walls all day long /Idolize they favourite rappers and know all they songs /Or for anyone who's ever been through sh*t in they lives /'Til they sit and they cry at night wishin’ they'd die /'Til they throw on a rap record and they sit and they vibe /We're nothin to you - but we're the f*ckin’ sh*t in they eyes /That's why we seize the moment, try to freeze it and own it /Squeeze it and hold it, cause we consider these minutes golden /And maybe they'll admit it when we're gone, just let our spirits live on /through our lyrics that you hear in our songs... (Sing For the Moment)

(If it looks like you’ve seen this before, I have posted most of it on my facebook notes before.)

On mental illness / addiction

Recently I went to a show by comedian Wil Anderson and he spoke of what we commonly call addiction and mental illness. Now, I don’t mean to spoil the show for anyone, but I thought some points he made were very valid (and hilarious).

Last week I wrote about the strain mental illness places on relationships and about having more tolerance for the mentally ill. The point arose about certain people then using their illness as an excuse to any and all misbehaviour. I suggested that the person whose behaviour is really a result of their mental illness and not just personality traits will often lack insight into what it is they are doing or saying, but upon being confronted will often be apologetic of their behaviour and try to change. The person who is simply someone acting wrongly and then not apologizing for their behaviour but rather suggesting it is all part of their illness and you are in fact wrong for judging them negatively – that person is most probably just a person will a bad attitude who happens to also have a mental illness. Of course, it’s not always that simple and the lines are often very blurry between what is intentional misbehaviour and what is sequelae to the condition. Now, let me raise another scenario (which Wil Anderson raised in the show): what about those people that don’t have a mental illness diagnosis misbehaving?

What I mean is people who are not known to be suffering any mental illness suddenly noted to be doing something wrong and then identifying themselves as mentally ill and thus not responsible for their misbehaviour. As an example suggested by Wil is someone like Tiger Woods who as far as everyone (even his partner) knew was just a normal guy doing extraordinary things on the golf course. Then it became widely known that he was engaging in sex with a lot of women outside of his marriage, and without the knowledge of his spouse. He didn’t deny what was reported, but he did then claim to have a sexual addiction which no-one not even close family and friends had ever known he had. Not having ever met Mr. Woods, I can’t comment on his specific case but the questions that arises are: Isn’t that suspect timing for a diagnosis? And is there such a thing as sexual addiction?

Diagnostically a mental disorder implies that there is interference in a person’s social and or psychological functioning due to the behaviour, for example loss of jobs or relationships, etc. Substance abuse / addiction implies that a ‘substance’, which can be anywhere from alcohol, heroin, or a behaviour such as gambling, continues to be used/repeated despite negative sequelae from it. For example, a person who uses intravenous heroin on the weekends for recreation and the rest of the week holds down a job and has a good relationship with friends and relatives and is not in financial strife isn’t a “heroin addict”, simply a heroin user. If as a result of his heroin use he came to lose his job, money, relationships, housing, etc. and still continued to use heroin despite this, then that person could be said to have an addiction. The interesting thing about celebrities claiming sexual addictions (or other mental illnesses for that matter) to account for their misbehaviour is that they do often lose out financially and psychosocially after their misbehaviour is uncovered. The usual course of the story is that they then enter an addiction rehab centre and they’re “cured”. Suspect? Maybe. Real? You could anecdotally note that celebrities seem to have a much lower relapse rate after rehab than your traditional addict entering a rehab program… or maybe they have better support systems as a result of money and/or fame or family and friends… or some would say maybe they were never sick in the first place. It’s easier to cure a paraplegic who can walk than one with a severed spinal cord.

What about sexual addiction? If it meets the criteria of interfering negatively on a person’s psychosocial functioning and the person continues to engage in it despite these negative effects, then a person can be addicted to almost any substance or behaviour. A person with a sexual addiction, for example, may continue to engage in repeated sexual activity until the extent that it impacts on their ability to hold down a job because they ‘need’/want sexual stimulation at regular times, they may struggle to keep stable romantic or even family/friend types of relationships because of promiscuity and perhaps even indiscrimination as to sexual partners or context; it may cause legal problems, and it may cause physical health complaints such as sexually-transmitted infections. The short answer is yes, there is such a thing as sexual addiction. Is everyone who cheats on their partner a ‘sex addict’, though? No, of course not. If he/she manages the rest of their life well and just happens to be very adept at concealing sexual encounters with other people from their partner, then they’re probably not ill, just claiming to be so as to deny responsibility for their behaviour. Which raises another concept Wil Anderson spoke about, you can’t be “a little” addicted, or “a little” mentally ill. Psychiatry makes it really easy, actually: you either meet the criteria for a mental disorder or you don’t.

And one last topical mention: Charlie Sheen. When he started shooting off his mouth, behaving differently to the ‘good boy’ Charlie Sheen we all for some reason thought we knew, people started branding him as “bipolar”. Now, Mr. Sheen himself denied ever being diagnosed with bipolar disorder and reported drug and alcohol use which he was not ashamed of. Was he lacking insight into the manic phase of a bipolar disorder? Could be. Or maybe he just wasn’t sick at all and is one of a few celebrities who is honest enough not to use a mental disorder as an excuse for general human misbehaviour.

On fate

If you know me, you'll know how I credit Napoleon Hill for the great change in my life that came about in 2006. Napoleon Hill wrote "motivational" material of the kind we commonly associate with self-help books. Throughout the years since, I've read a lot of material from Napoleon Hill and other similar writers, including Tony Robbins.

Back in 2006 I was in a bit of a dark hole, emotionally and spiritually. I took a year off medical school to sort myself out. To re-evaluate not only if I wanted to finish my course, but also if my total existence was worthy of effort. I didn't feel hard-done by the world; I just had allowed myself to exist without a known cause to justify my existence. Now, not many people will go through these "existential crises" because we are either in good environments with supportive people, or we have external passions, or quite simply questioning your reason for existence is just not something that would capture our attention at all given all the other tasks of life. I, however, like to question everything. So I started questioning and I just couldn't identify many reasons why I should continue to be alive. I at that stage wasn't suicidal, no, that's not what I mean. I did however "wish" for an alternative to my current life. I wished for disease, for sudden death, for a road accident, for natural disasters, etc. But it wasn't all negative, I also wished for "love", for money even, for artistic success, for a child, for anything that would take me out of my then empty life to elsewhere. I wanted anything, good or bad - as long as it came to me and I didn't have to do anything to get it. I believed that fate had brought me to this slump, but that it would equally bail me out. It was then I started reading Napoleon Hill's work and realized that all these things, these "good" things that happened to some “lucky” people (unlike myself) didn't just happen due to fate.

Napoleon Hill tells a story at the start of the book 'Success Through a Positive Mental Attitude' about a poor family in which the child asks his mother why his family is poor. The child is pondering his own “fate” to grow up and become a poor man himself like every other member of his family. Now, the obvious response seems at first to be 'we're poor because our parents were poor like their parents before them, etc.' Or ‘we’re poor because we can’t afford the type of education others can’. Or ‘we’re poor because we are of this race, or culture, or religion, etc’. However, is it an unchangeable fate that some families or some people are born either poor or successful? The mother explains "We are poor, not because of God. We are poor because... no-one in our family has ever developed a desire to be anything else”. Now that seems like a simple statement, but if you consider that the family in question was an African-American family, not too many generations removed from slavery and oppression, and that the child that asked the question became a very wealthy businessman, you can begin to understand the paralysing effect our belief in fate can bring.

In relationships many of us believe that fate will bring us the “right” man or woman. And not only that, we also believe that fate will determine the length or strength of that relationship. Fate will decide if we have children or not. Fate will decide if we have a “good” or a “bad” partner and whether we ourselves are good or bad. So no longer are we in control of the relationship, or of our role in it, but this external entity we call fate is. Why try, then, if it is all up to fate? The other comfortable position we can adopt is to say we are simply bad at relationships. And we may well have reasons to be bad at relationships; maybe we didn’t have the best role models, maybe we have low self-esteem due to any number of things, maybe we had a prejudicial childhood or subject to trauma somewhere in our past. All these things shape us, of course, but insight is often the first key to unlock us from this uncontrollable thing called fate. However, you can unlock a person from slavery, from trauma, and then it is up to the person to walk out of his/her cell. As a result of all the abuse and trauma maybe the person is initially too weak to walk through the door alone, but how long should we keep using that excuse? After a week? A month? A year? Ten years? The rest of our lives? It’s really up to the individual person, isn’t it? We may not have been responsible for our pasts but we are in control to shape our futures. Things don’t always just happen to us, some things we can make happen too. Acknowledging that is isn’t accepting blame for our pasts; it is accepting the challenge to steer our own future.

Similarly in our careers or vocational aspirations. Too often I hear people tell me that they wish they could do that job but they’re doing this other one because not many people get to do that job. But somebody will get those jobs, right? Why can’t that somebody be you? People will then proceed to tell you excuses (aka “reasons”) why they believe it can’t be them. They need more education, those jobs are for people who know other people, you need money to get into that field, you would need to relocate elsewhere, etc. So? The great thing about these “reasons” are that perhaps you in fact need to see them as steps rather than excuses. So if you have to know someone, why not get yourself known to someone? If you need more education, why not apply for a further education course? See, yet it is so easy to say that fate would have it that you don’t (yet) know the right people, you don’t (yet) have the money, etc. We become victims of our fate and also of our past – and that is how we remain stagnant. We may in time come to blame fate for the job we don’t have, the money we don’t earn, the associates we can’t exactly call friends. It is easy to blame an external entity – but we don’t have to be victims of any past or future if we take responsibility for our role in our own lives.

The last thing I want to consider is our great fear of control, or what is more commonly called accountability. I know, I know, we think we all want control, right? Everyone wants control, but no-one wants to be held accountable for their actions. So we hesitate to dream, to aspire to anything, to want or demand change. We would rather place our faith in this mystical thing called fate. ‘If fate will have it, I will have a good marriage. If fate will have it, I will enjoy this new job. If fate will have it, I will be financially successful in my career...’ People look to horoscopes to fuel their faith. If a thing I want is suggested by my horoscope, then it is okay to want it. If my horoscope says I am not to have something, then I am bound to have this fate happen to me. Now, you may have heard of this thing called self-fulfilling prophecies. I speak of it in terms of horoscopes because it is the most obvious example. Often a horoscope will tell you a general bit of information that describes you – ok, you agree with it (e.g. “oh yes, I am calm like other virgos). Then it tells you something vague but positive about what will happen to you – and you can always identify at least one instance of this happening. For example, ‘you will meet a handsome stranger’ can mean that guy that looked at you on the bus. You were alert to this and so you see your destiny being fulfilled. Had you not been alerted to the fact you may not even have noticed anyone on the bus even if he was very overtly trying to capture your attention. Similarly, it may be with career success, financial wealth, etc. It is like we are free to allow good things to happen to us – or god forbid and we actually act in order to have good things happen to us – only if we are devoid of the accountability for our futures. Accountability becomes a thing to shun not only in regard to negative consequences, but also in potentially positive ones. No one wants to say they tried and did not succeed at this instance. It is so much easier to say that it was our fate to fail.

On doing it all over again

There’s a saying in Spanish that says that man is the only species to trip on the same stone twice. In fact, I remember reading in a neuroscience text once about how homo sapiens is the only species that despite having suffered an adverse reaction to something that they ate, would be willing to eat it again. Are we stupid? Or are we the only species capable of hope?

Behavioural research experiments have shown that almost any living animal can be “taught” to respond in a predictable manner. You show a dog food and they instinctively salivate. You show a dog some food and sound a bell at the same time and the dog salivates. You do that enough times and the dog will come to associate the bell (not just food – and in fact, soon only the bell without the food) with salivation. You can train almost any animal to respond like this.

Most animals can also “teach” themselves (or their trainers) to respond in a certain manner. For example, a pigeon may notice once that when he spun to the right, he received a food reward. He will spin to the right again and see if he gets more food. Maybe he does, maybe he doesn’t, but it’s worth another shot, right? Of course, look at what’s at stake! There’s a perceived benefit to doing something in a particular way. Soon, the pigeon may find himself spinning and spinning, awaiting his reward and perhaps only erratically receiving it. Maybe he has to spin ten times before he is rewarded just once, the next time maybe only twice, the next feed may be 100 spins away – but it always seems so worth it!

The scenario described above about the pigeon is often quoted as an example of how almost any living creature is capable of superstition. A person or animal can do something because they believe they will receive a particular response, regardless of whether the behavior and the reward are causally linked. This belief can consist of a primitive or instinctive behavior in any animal or it can be a complex behavior derived from a complex centralized neurophysiological process (such as a ‘planned’ behavior initiated in a human cerebral cortex). Now, along with the concept of superstition comes the concept of addiction. A creature can derive so much pleasure from a thing (food, physical sensation, drug, drink, etc.), that he will continue to engage in repetitive behavior in order to attain it. He can continue to engage in the behavior even when he only seldom receives the reward, or even when as a result of behaving a certain way he suffers negatively. Why does this happen? Because some things seem so worth it!

We are very much like animals in some ways, and yet why is the human species different to other complex animals? Is it the cerebral cortex and its ability to house our sense of conscious planning, to perceive time, to exercise self-control, and to delay pleasure for perceived greater reward? Or is it our ability to hope and believe - even when what we believe is not biologically advantageous? To believe in things like love.

Most higher species are capable of caring for their young and will engage in what to the human eye appears to be affection. But can other animals love? What is love? I pose this question because love is one of the most addictive things on this planet. The reward, the pleasure in it, is that warm sensation of being "in love" and - if we're lucky enough - also of being loved. You fall in love and you forget about all those other times you thought you were in love. You forget of how much it hurt, you forget how hard it is to make any relationship work, you forget that every interaction with another human being will involve friction regardless of how much the people involved love each other. You risk hurting again. You risk losing. You risk your time, efforts, and emotional investment. You risk it even though you know the statistics. We tell ourselves 'no, this time it'll be perfect, we'll make it work, etc.' The reality is that from one relationship to the next we change very little yet expect a different result, a much more pleasant and successful result, each time. That is the stuff of superstitions, of addiction, of madness. And yet we do it. We fall in love again and again like a junkie addicted to the high. And we do it all because taking the risk - and the potential reward – seems AND IS so damn worth it!

On something unpleasant

Today I want to discuss something really unpleasant. I want to discuss it because I believe everyone, especially those who have children, have to at least intellectually contemplate this so they may never have to deal with this personally.

One of the most ignorant things I ever heard when I was a kid was a family friend of ours saying that a child from our neighbourhood had lied about being sexually abused. I guess what I found so ignorant about it was the spite (towards the child not the abuser) that she said it with. The story was that a child from our neighbourhood had confessed to her family that years before a male family friend/relative had sexually abused her. The abuser was well-known in the community as a “nice, normal guy”. He had many adult friends, one of which was this woman that said the child was lying, and there was nothing on the surface abnormal about him. The reason this woman said the child must have been lying was because she did not believe that the person named as the abuser looked like a “bad guy”, or that a child could hold a secret for that long, or that no child was “stupid” enough to allow sexual abuse to occur. Those ignorant things are what really stirred in me the need to better educate people on childhood sexual abuse. I can’t imagine anything more damaging than allowing people to believe that children are sexually abused because of the child’s own fault.

I wasn’t able to completely put my thoughts together on what exactly about childhood sexual abuse was not properly understood, and I guess I never should have expected to because the information was hard to come by and the topic is generally avoided. Then as a medical student some years ago when I was doing my mental health rotation, one of our supervisors suggested I read an article about the childhood sexual abuse accommodation syndrome. We were on a ward where the majority of patients were women with personality disorders, and almost invariably, a childhood history of sexual abuse so he thought it beneficial to understand a little of their background. The article was written in 1983 by Ronald Summit and I’ll briefly summarise what it talks about.

The childhood sexual abuse accommodation syndrome describes in a sort of timeline how the sexual abuse of children comes about and then the social and family-dynamic consequences of it. The process is generally broken down in five steps: 1) Secrecy, 2) Helplessness, 3) Entrapment and accommodation, 4) Delayed, conflicted and unconvincing disclosure, 5) Retraction.

1) Secrecy.
Who most commonly abuses children? Parents, stepparents, uncles, siblings, close family friends, teachers, religious ministers, etc. – essentially people in positions of trust to a family. Why they do it is a completely different discussion which I won’t go into here. The general belief is that it’s not a sexual-gratification motive, but rather one of establishing control. I believe it is probably both because generally these “nice people” who wouldn’t hurt a fly (hence their trusted roles in communities) have sexual feelings that for whatever reason are deflected onto children. Maybe they lack self-esteem in approaching other adults for sexual intimacy, maybe they see themselves as children themselves because of their own stunted emotional development, maybe they find the prepubescent physical characteristics of children more arousing than the adult physique, etc. Whatever the reason may be, the factor that unfortunately completes this equation to allow sexual abuse to happen is that children more than just been vulnerable, are also usually actively seeking of affection and from adults – and it is this that paedophiles take advantage of. The child is sworn to secrecy while the abuse goes on, and in return (at least initially) he receives very special and personal attention from their abuser. The secrecy of it all is perpetuated by the fact that the abuser either directly threatens harm to the child or family, or it is understood that if he/she discloses the abuse that he/she will generally face negative consequences of the likes of separating a family unit, admitting “wrong-doing”, facing shame in revealing the details of the abuse, etc.

2) Helplessness.
As a consequence of the sworn secrecy, the child is then locked into a helpless situation where he/she can’t tell anyone of the abuse and is also too physically and/or psychologically immature to fight off the abuser. A child may not like being hurt or sexually humiliated, but he also has a sense of not wanting to hurt the parent/friend/sibling, etc. that is abusing them. Children are way more self-sacrificial than we realize. On the other hand, it’s also possible the child is either precociously or physiologically passing through puberty where the sexual stimulation that the abuser procures for his advantage is also exciting to the child. This is an absolutely normal physical response, but one that the abuser will use to try to justify the abuse and may also extend the period of time the abuse occurs for. The child will eventually experience guilt but finds himself in a position where confessing the abuse also feels like admitting wrongdoing, and experiencing shame as a result of this. In this helpless situation the abuse is able to persist.

3) Entrapment and accommodation.
A person caught in a situation that they can’t physically escape from or stop, naturally develops psychological defences that allow them to distance themselves from the abuse. Children, even very young children, can learn to disassociate from unpleasant realities by psychologically separating their external/physical experience from their internal world. These defence mechanism are what allows the child to survive, but they often will then extend into other aspects of the child’s life, and will often stick with them through to adulthood. A child can eventually become an adult that is difficult to engage emotionally, that flees from emotionally-confronting situations like romantic relationships. Also, the abuse itself can become the punishment the child feels they deserve because they internalize their involvement in a “bad” situation as being a result of themselves being bad. People can go on for years perpetually recreating their childhoods in order to punish themselves, to attempt to “fix” a previous pattern (and inevitably instead repeating it), and also recreating the situations they know they can survive even though these situations were never pleasant. As an example of this, consider the fact that most people that were abused in childhood were often abused by more than one aggressor. Were they asking for it? No, of course not! But behaviourally they had come to know techniques (perhaps sexually-arousing techniques) that they had from personal experience known to please certain adults with paedophilic tendencies. We’ve all known of a precocious child and yet understood that they are a child and their behaviour was not something to take advantage of. Imagine a similar child who is only recreating what a previous abuser had “taught” them, and incidentally in their community encounters another abuser. A child may enter one after another child-abuser relationship. The child’s behaviour becomes both shaped by and perpetuates a life of abuse.

4) Delayed, conflicted and unconvincing disclosure.
Eventually a child, or more commonly an adult, will confess past sexual abuse. This is usually the first step in the healing process, which is why it is such a shame that most people don’t get past this step. The reason most people do eventually confess is not to seek punishment for the abuser but rather as a cathartic experience to free themselves from internal conflict. This is one thing that the adult parent or caretaker often misunderstands and for that reason many children are thought to be “making up stories” about a stepparent/sibling/teacher, etc. People also question the person’s confession because they don’t believe the abuser, such a trusted community member, would be capable of taking advantage of a child for sexual gratification; or they don’t understand why a child would delay this confession. This last reason is so hurtful because it is such a self-centered reason. The adult caretaker to whom the confession is made has certain concepts of themselves, as we all do. They believe themselves to be approachable, trustworthy, caring, protective of the child, and also with good judgement in the people they associate with and allow near their child. For this person to believe the child’s story is also to question their own integrity in their child-rearing abilities, to allow themselves to share in the blame. Of course, this is not the case! The true fact is that the abuser abuses the child AND the caretakers’ trust. A caretaker may seek to know exact details of acts committed and will interrogate the already ashamed and frightened child for this embarrassing information. The child, in turn, as a result of previous disassociation techniques that allowed them to survive the abuse, may not even be able to recall exact details, and so the child’s testimony is considered unreliable by questioning adults. In all, at a time of such crisis, blame is what is thrown around rather than proceeding from them on to soothe the child who is facing all sorts of new conflicts now too.

5) Retraction.
The family and/or the community is thrown into turmoil. People side with either the child or the abuser and seek to punish one or the other. Others disagree in the disclosure altogether because it may tarnish a respected member of society’s reputation. The child, as he has learnt before that he is ‘bad’ and brings about ‘bad’ things, believes the whole turmoil is his sole fault for disclosing what he could have continued to keep quite. As I mentioned before, children can be way more self-sacrificial than we realise, and as such a large proportion of the children who once admitted childhood sexual abuse, will then go on to retract their confession in order to return order, trust, and harmony to a family or community. It’s sad because the story people come to conclude is that there was a child who accused someone of sexually abusing them, but then he confessed he was lying about it all. That to me, is the sad thing about how misunderstood this issue is.

Thanks for reading. And, please, keep this in mind if you’re ever in a position to help a child or someone who has gone through this hell.

On ‘childish’ people and abuse

I met a lady in Chile who asked me if I knew why some people are just so childish. She was talking about members of her own family, and I guess she asked me because she thought I might have learnt something about this in my psychology classes. I didn’t. I had read a little about post-abuse syndromes, though (e.g. the child sexual abuse accommodation syndrome). Now, an example of the “childish” behaviour she was talking about is two adult siblings bickering and maybe even physically confronting each other, divulging each other’s secrets in order to offend or hurt the other, pitting other family members against each other, etc. Immature behaviour? Yes. Childish? Maybe not the best word to use; children often lack the noxious intent adults seem to use. There are many adults, though, who having the skills and abilities of an adult, behave (and usually also think) as children.

I don’t mean adults acting like children in a derogatory way. I mean adults acting in “immature” ways, as in the mature versus immature coping mechanisms psychology tells us about. For example, say someone cuts you off in traffic. The mature thing to do is acknowledge you’ve been wronged, but given that the situation is fleeting and didn’t result in greater harm, you acknowledge your emotion (anger, sadness, etc.) and move on. The immature thing to do is to scream your head off at the other driver, maybe tailgate him, maybe become physically abusive if you get the chance to. The reason it would be an immature thing to do is because the reaction is disproportionate to the slight – and because you didn’t exercise self-control in response to the emotion you felt. OK, so there are immature and mature behaviours or responses that are designated as such by social norms, moral and psychosocial values, prevalence rates, etc. Now, the very same things that determine whether a behaviour is a mature or an immature response usually have to be learnt – and often in childhood. You can see this way that if you didn’t learn these things in childhood, how to behave “maturely”, the only way you know to respond is in a child-like manner: instinct and survival based, with immediacy, and without regulation of affect.

One of the things I remember reading about children who are abused (whether emotionally, physically, sexually, or whatever other horrible way we have to inflict suffering) is that their emotional development is gravely stunted. These children will have normal psychosocial and cognitive development until the point where they encounter the abuse, then will often remain in that stage of psychocognitive development until adulthood. You can see, therefore, how it follows that individuals that behave childishly are doing so because that is all they know. They react and act like a child because they haven’t learnt any other way to be. Of course, on the receiving end of it, when you as an adult encounter these people who are also physically adult like yourself, you expect them to act like you would and when they don’t we label them as childish.

So that is what I told my friend in Chile, that that at least was my understanding of how some people act the way they do. But in telling this story, you also must think about the people that have the background of childhood abuse and who have learnt to behave more maturely than a child would.

Abuse tends to rid us of many choices, of many liberties and human rights, and especially in childhood can be absolutely shattering to a person. But for those that are fortunate enough, to have escaped childhood abuse and reached a plateau into adult life, there is one choice, one moment of insight, that is all-empowering: making the choice of continuing to be the abused child of the past or becoming the adult that takes responsibility for his/her future experiences. Of course, I am trivializing a lot of things, and sorting through the behaviours and thought patterns of previous abuse victims, identifying the cognitive errors that have been laid down over repeated exposure to abuse, and eventually changing these behaviours, can take years (if ever achieved). The hardest thing to do isn’t doing all the cognitive work, however, it is that first step: believing that you, even you as a victim of abuse, now have power to decide to change things. To me, the difference between two people who have suffered childhood abuse, one who is mature and one who is immature in his interrelational style is that one of them had a moment of insight when he finally understood the words:

“You’re not powerless. You are not sick. You did not deserve what you got, but things can be better.”

Now, my friend in Chile is a very mature, very humble, and very loving person. When I told her about how some of these ‘childish’ people possibly had a troubled childhood, and are possibly cognitively and emotionally stuck there through little fault of their own, she bowed her head down as if remembering some distant memory only she knows about and told me how she really did feel sorry for her family members, even if they did act so negatively and immaturely towards others. And I guess that’s the other point I wanted to make, that perhaps instead of been irritated by these “childish” people, we take a moment to reflect on how sad their lives have probably been.

On homosexuality, the DSM, and Pedophilia...

When I was younger people used to tell me that homosexual people were bad, that they were defective, that they were evil. These people were well-meaning religious clerics, family, family friends, school teachers, and other respectable adults. I emphasize well-meaning because their attitudes were not what we now commonly refer to as homophobic, discriminatory, judgemental, ignorant, or bigoted. Their views reflected a common majority view. They weren’t bad people saying derogatory things about a minority group of people; they were just repeating what was common thought at the time. These were good people.

Now, the common view at the time –that homosexual persons were sexual deviants, less than healthy “normal” humans- was grounded in the scientific and medical descriptions accepted until very late in human history. The Diagnostic and Statistical Manual of Mental Disorders (DSM) classified homosexuality as a mental disorder until as late as 1973, as did the World Health Organisation in its International Classification of Diseases (ICD). Gradually in a period since the mid 1970s the classification of mental illness was ratified with increasing knowledge of prevalence and non-observance of the common disclaimer in these classification systems: “the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning”. If a behaviour is sufficiently common and does not cause significant negative outcomes, then it is a tough call to call it a mental disorder.

Of course, the other thing that happened since the inception of the DSM and similar classification systems and the 1970s was the so-called “sexual revolution” of the 1960s. The sexual revolution abolished many taboos (or perhaps constraints) on sexual activity. One such taboo was that of sexual activity between members of the same (phenotypic) sex. As a result of the sexual revolution a lot of people came to experiment with all different forms of sexual expression, although most commonly this was frequent non-monogamous heterosexual intercourse. So one could pose the question, did this social breakdown of a variety of sexual taboos (at the time they called it something akin to generalised immorality or looseness) lead to the increased acceptance of the people who engage in homosexual activity just because homosexual interaction happened to be one of those taboos? Perhaps, but it most likely was also (at least in addition) due to the lack of findings of “dysfunction” from medical and scientific point of views.

Recently I attended a talk on psychopathology, or, actually, the classification of mental disorders. The question was posed: what is a mental disorder? Something that is inherently bad? Something bad because some scientists and medical doctors said so? Something that makes the affected person or ones associated to him or her feel bad? Something that makes the affected person unable to function effectively or satisfactorily in his micro- or macrocosm? A behaviour that is uncommon in a particular environment or situation? A behaviour politicians and lawmakers decided is bad? A behaviour that a large proportion of the person’s peers would judge unreasonable or bad? Now, regarding homosexuality and its transition in classification systems from “bad” to “normal”, we could answer this question in many of the dimensions posed above. But my point is not to argue “homosexuality: good or bad?” but rather to provide a backdrop to one scenario posed to me, which at first sight scared me deeply, so I want to finally address it and put it to rest.

Now, to speak of the scenario posed to me (and that use to plague me), I have to first emphasize I’m playing devil’s advocate here. As I mentioned before, I grew up being told that homosexuality is bad, homosexuals are deviants, abnormal, less than, etc. Gradually that story changed and homosexual persons became persons (foremost) who happened to engage in homosexual activity. What if it were possible that this happen to other behaviours currently considered "abnormal"; that they also went from being described by others as “bad” to now being described as “normal”? And this change could come about through change in social attitude or the discovery of a high prevalence of the condition. After all, if all the people of the town are crazy and the king is sane, then for being a sane minority the king will be considered crazy by the townsfolk. The scenario posed was about pedophilia.

The DSM-IV-TR classifies pedophilia as a paraphilia in which there are “over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges or behaviours involving sexual activity with a pre-pubescent child or children; and the person is at least age 16 years and at least 5 years older than the child”. Of course, it includes the common DSM disclaimer, “the fantasies, sexual urges, or behaviours cause clinically significant distress or impairment in social, occupation, or other important areas of functioning”. Now consider a world where pedophilia occurs in every culture and ethnic group, in members of different socioeconomic classes, includes members from across all professions and trades; a world where 1 in 4 girls and 1 in 7 boys are sexually interfered with by an adult; and a world where people have become too accustomed to saying “it’s OK because everyone does it”. This is exactly the world we live in! So is it purely OK, really “normal”, if prevalence rates are high enough? (I hope not.)

In a hypothetical new and vile world, imagine seeing children talking to each other in a playground. One asks, ‘so when did your daddy devirginize you’? The other answers, ‘I was six. Hurt like hell. Now we only do it in the shed every week when mum’s not home’. A third one says, ‘you’re lucky. My mum’s friend did me when I was four – and I can’t even remember the first time’. Cut ahead to a generation from that and cutting scars on human forearms have become the norm so much that you’d think this is how we were born, with multiple lacerations tracking from our wrists to our shoulders. There’s no taboo about it. The kids go out with daddy for their fishing and “playing” trips. Mum knows, dad is not ashamed, and the children all share their common carnal knowledge amongst themselves at school. The mental disorder classification books no longer include any lifestyle choices or paraphilias anymore....

But wait, to wake yourself up from this nightmare, remember that one disclaimer in the definitions of illness: “the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning”. Despite the unfortunately high prevalence of pedophilia in this world, the fact that it is harmful makes it not classifiable as a variant of normality we will/should all just accept. Child sexual abuse has no advantages except to the perpetrator, it’s an abuse relationship, a two-party transaction with only one person benefiting. In legal terms they would equate this to at least theft. You can’t steal from a child and say he consented because he would trade in a bar of gold for a simple candy, lacking that knowledge of how things done today can affect your whole life to come. You can’t just say homosexuality is the same as pedophilia because they are both types of sexual interactions; so is heterosexual intercourse, and why do less people compare that to pedophilia? Because there are differences!

From 2006 to 2010 there existed a political party in the Netherlands (PVND) that provided political advocacy for pedophile groups and organisations. One of their agendas was to legalize child pornography and to lower the legal age of consent to sex down to 12 years old. Commonly pedophile groups argue that children have the ability (and so the right) to enjoy sexual activity alone, with their peers, or with an older adult. Consequently, they argue, if the child consents to the sexual contact, then it should be legal for the adult/s to engage so with them. They’ll go so far as to argue that sexual contact with children is “good for them” and their development. Of course the issue that is of concern to other (non-pedophile) adults is that children’s ability to consent is limited by their experience and knowledge of consequences. A child can know that candy has a pleasant flavour, for example, and he can decide / consent to eat that given to him by his parent or friend, but the consequences of eating a piece of candy (e.g. early tooth decay, or not wanting to eat the rest of his dinner afterwards) are hardly the same as “consenting” to sexual activity. The consequences of childhood sexual abuse are commonly seen in our psychiatric wards, in the patients we all struggle to interact with: the personality disordered, the limitless cases of deliberate self-injury and drug abuse, the repeat victims of domestic abuse who go around either recreating or trying to erase their childhood experiences. This is too sad – and the worst thing we can do is blame the child, say he or she “consented”.

Pedophiles abuse people; they cause harm. This is not a time- or era-dependent opinion. It is so not the same as homosexuality or heterosexuality or any other way competently-consenting adults choose to interact sexually. And I think we have all come to that same conclusion. The only thing for us as a society still to debate about this and many other negative actions towards other human beings (e.g. murder) is whether such acts constitute criminality or mental illness, and which are the best ways to decrease our childhood sexual abuse rates.

(Sorry for the discussion on homosexuality together with pedophilia, I was obviously mainly aiming to contrast not compare.)