Sexual Abuse as a Cultural Concern

Over the past 30 years, largely as a result of the women's movement, the topic of sexual abuse has emerged into public discussion. Talking in public about abuse of any kind is a relatively new cultural phenomenon, particularly talking about abuse within families. Historically, sexual abuse has been publicly acknowledged most often as a war crime, where the so-called "enemy" abused the men, women and children of whatever group they were fighting against. The idea that abuse could happen within a family has not been taboo; it simply has not been a concept. Sandra Butler, who wrote one of the earlier books on incest, Conspiracy of Silence: The Trauma of Incest^ talks about how, during her research for that book, most helping professionals told her that incest did not occur in their communities (1980: 48). This was less than 20 years ago! I believe that the recent public acknowledgment of sexual abuse offers an opportunity to examine the cultural context in which such abuse occurs and to explore possible ways of decreasing the incidence of sexual abuse. In the first section of this article the basic background of abuse is reviewed; then process-oriented approaches to the issue are discussed.¹

Sexual abuse is still most often framed in terms of the victim and the perpetrator. Most discussion of sexual abuse is geared toward survivors and helping professionals, with far less attention paid to the context in which abuse occurs. Focus on treatment of abuse survivors is essential and must continue. In addition, I believe that community involvement is essential if we desire to greatly decrease the incidence of sexual abuse.

For ease of discussion in this article, I will focus mostly on sexual abuse of children, who are the most frequent victims of sexual abuse.² Most sexual abuse takes place in either the immediate or the extended family, and children usually know their abusers, who are most commonly fathers and stepfathers, and then other family members—mothers, uncles, grandparents and siblings. The next most frequent level of abuse is by known community members—day care providers, baby-sitters, coaches, religious authorities and other people in positions of power.

The media focus more on molestation and abduction by strangers than on stories of abuse by trusted adults. Abuse by strangers clearly is a serious problem, but most children who are molested are not abused by strangers. Gradually the media have begun to focus on sexual abuse by community members, such as those mentioned above. What is remarkable is the absence of stories about boys and girls molested within their families. Part of the reason to keep these stories out of the news has to do with protecting children from public exposure, but protection of children does not explain the lack of information in mainstream media about the extent of incest. I believe that although sexual abuse is a problem represented in the media because unless we have been touched personally by sexual abuse, it's easier to think sexual abuse happens "out there" and not in our own homes or the homes of people we know. In addition, most of what happens in families, including abuse and murder, is still considered private domain.

This inaccurate portrayal of the extent of incest is one example of how society colludes with child sexual abuse, particularly with incest, through minimizing the nature and extent of the problem. Through their silence, the media support the notion that most common kinds of sexual abuse are not newsworthy and therefore may actually be considered "normal." The media, however, are not to blame. The lack of accurate coverage of abuse is directly connected to how difficult it is for all of us to acknowledge the extent of its occurrence. Sexual abuse is a difficult topic, and denial is a function of being alive. It is next to impossible to realize how closely sexual abuse touches all of us, and to admit that it is a problem only the community as a whole is strong enough to solve.

Closer to home: the statistics

Sexual abuse ranges from literal sexual acts with children to the kind of emotional incest where an adult turns to a child to meet emotional or sexual needs in a way that places inappropriate demands on the relationship between adult and child. As survivors of sexual abuse speak out and treatment professionals recognize aftereffects of sexual abuse, we develop more accurate statistics about the extent of abuse. Currently, 33% of girls are believed to be victims of sexual abuse. The statistics about the number of boys who have been molested are increasing as more boys and men speak about their experiences. Our mainstream culture, which pressures men not to be "weak" or show pain, adds to the shame and silence created by sexual abuse. It is commonly accepted that 16% of male children have been sexually abused (Young-Eisendrath, 1993; Russell, 1984; Crewdson, 1988).

Widespread beliefs about sexual abuse are often in direct conflict with the facts. Some of these myths include that sexual abuse is most often perpetrated by strangers, and homosexuals. Another inaccurate assumption about sexual abuse is that it happens mostly in poor families or families that belong to ethnic minorities. These various fallacies are all based on stereotypes in our culture about who the "other" is. Sexual abuse happens everywhere, regardless of class, race, religion, gender and other categories. The greatest number of people who sexually abuse others are heterosexual men, with father-daughter incest being the most common relationship.

If we start to think about these statistics, it becomes clear that sexual abuse is a problem that touches everyone. Between 25% and 50% of the people we meet every day have been sexually abused—and these statistics are based primarily on reported cases of abuse. Everyone who has been abused was misused by another human being, which also means that a huge percentage of the people we meet every day have perpetrated sexual abuse. Most perpetrators were themselves abused. Sexual abuse is clearly a systemic social problem that requires systemic focus beyond treatment of survivors and perpetrators.

Effects of sexual abuse

The effects of sexual abuse, in and of themselves, can make it extremely difficult for survivors to address the problem of abuse on a social level. Survivors are often busy with survival and then recovery; speaking out can come only after basic survival issues are addressed. Individuals are unique, and everyone who survives abuse has unique repercussions. Most survivors of child sexual abuse feel the abuse impacts them as adults, and for many, the effects can be debilitating.

Possible effects of sexual abuse include emotional and mental difficulties such as increased anxiety, depression, insomnia, nightmares, self-mutilation and other self-abusive behavior, suicidal ideation and suicide attempts, alcohol and drug addiction, eating disorders, extreme states, memory problems and fear of people. A high percentage of women who become anorexic have been sexually abused, as have many people who later become addicted to drugs and alcohol. Sexual abuse is a trauma, and many survivors suffer from symptoms of post-traumatic stress disorder, which may include nightmares, exaggerated startle response, obsessive thinking about the events, generated fear, anxiety and depression.

Many survivors feel that childhood sexual abuse has negatively impacted their adult sex lives, some to the point that they prefer not to be sexual.³ Sexual difficulties may include flashbacks to original scenes of abuse during sexual activity, feelings of shame about sex, difficulty initiating sex, trouble feeling during sex and problems with becoming or staying aroused.

Relationship problems for abuse survivors may include lack of trust, feelings of being "one down" or of being superior, expectations of being mistreated, not noticing when one is mistreated, and involvement with abusive partners (including pimps or partners to whom one feels superior). Many survivors experience physical symptoms, often in the genital area. Other common physical symptoms include panic attacks, abdominal pain, migraine and throat and mouth symptoms.

Myriad other effects may be less obviously related to the abuse. One common effect is a lack of trust in one's own perceptions. This may be because a child has literally been told "this isn't happening" or the abuse may have been framed as "teaching about love" or "a special game." Even without explicit reframing of abuse, a child who is abused by an adult in a position of trust and responsibility has almost no way to question the experience. Children are far more inclined to think "it must be okay" or "something must be wrong with me or this wouldn't be happening" than to think "this is not right." This deep need to put aside certain experiences of the abuse, such as fear, shame, anger and sadness, often leads to the survivor's lack of trust in his or her own feelings and perceptions.

Another insidious effect of abuse is a silent state, the feeling of not being able to speak up or out. In many cases this is due to an explicit threat such as "don't tell anyone this happened." Such threats are often coupled with threats to the child's safety or the safety of other important people, i.e., "If you tell, I'll hurt your sister too" or "If you tell, they'll take you away from the family."

Knowing the effects of abuse is sobering, especially when we remember the number of people who are abused.⁴ Clearly, sexual abuse is not an isolated problem that happens somewhere out there. The likelihood that each of us will be close at some time in our lives to a person who is dealing with the aftereffects of abuse is yet another reason to conclude that sexual abuse is everybody's problem.

Shifting values

In the United States today, "family values" is a political catch phrase dropped by politicians, on talk shows, at the petition table in front of the grocery store. I see the emphasis on family values as indicative of a shift of power within the Western world that is shaking up families at the very core. In the years since the advent of modern feminism, women have begun to have a voice in many arenas that were previously forbidden to them. The structure of the heterosexual marriage institution and the biological family has a long history, based on property. Marriage served to transfer property such as land, animals, jewels or money from the father of the bride to her new husband. The family historically has been a hierarchical, power-based institution, with a man at the head of the power structure and the women and children below (Degler, 1980).

In this context, it is clear how abuse per se has not been a concept. If women and children are property, they are not people with equal rights. There is no legal recourse, or cultural framework to protest, if someone breaks a table, throws away a dish they don't want, or mistreats people who are considered their property. In fact, the social structure serves well to support abuse.

It was not until the 17 century that children were seen as different from adults. A framework that views children the same as adults will accept adults having sexual relationships with children and will also assume that children can give consent to such relationships (Crewdson, 1988; Degler, 1980). Culture serves to uphold the status quo through supporting the traditional balance of power, in this case, adult male power over women and children. From this perspective, if a woman or child spoke out about abuse, who would, or could, listen? Historically, anyone who believed and took seriously the complaints of women and children challenged the structure of the culture. This has held true even for people in power positions within the cultural hierarchy. A fascinating illustration of this is what happened to Freud, who is commonly considered the founder of Western psychology.

Suppression of the seduction theory: cultural disbelief

By the end of the nineteenth century, Freud had done extensive research with women clients who suffered from what was then called hysteria, a combination of symptoms including anxiety, hallucinations, fear, uncontrollable impulses and diverse somatic complaints. In 1896 he presented The Aetiology of Hysteria, a paper based on 18 of his case studies. In this paper, he stated that "at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience" (Freud, 1896, in Jones, 1956: 198). In other words, the girls and women he saw in his office had been sexually abused, and their symptoms resulted from the trauma of sexual abuse. Under immense pressure from his academic community, Freud changed his theory to say that the women had not actually been abused, but were responding to their disguised wishes for sexual contact (Masson, 1984; Herman, 1992).

In this case, Freud was acting as a spokesperson for those without power—children and adults who had been sexually abused as children. His environment refused to believe his findings and essentially said, "We will not tolerate this." Freud found himself at this point in a different role than the one he usually held as a white educated man. He was for a moment in a similar position as the women in his practice, who were not believed when they spoke out, who were told that they must be delusional and that such things couldn't really be happening.

After the suppression of Freud's seduction theory the topic of abuse went underground until the advent of feminism, when groups of women began to speak out about their experiences and memories. Remarkable changes have occurred over the past 30 years. The services and opportunities available for sexual abuse survivors and treatment for perpetrators have increased dramatically.⁵ Therapists have learned a great deal about working with sexual abuse survivors in individual therapy, and many support and therapy groups can help alleviate the sense of shame and isolation that many abuse survivors experience. The cultural container is also beginning to shift, and in many places it is acknowledged that adults can and do take advantage of children. What has not yet occurred is the culture as a whole taking responsibility for decreasing the incidence of sexual abuse.

Throughout history we see cultures react to horrible events through attempting to suppress them. In Trauma and Recovery (1992), Judith Herman argues that traumatic events are so horrific that it is difficult to hold them in individual or collective consciousness. As a result, information about systemic abuse periodically comes to light and is then repressed, individually and collectively. Despite memories, photographs and other accurate records of the Holocaust of World War II, various groups continue to argue that these atrocities simply did not occur.

Similarly, as more people speak out about child sexual abuse, we see a movement toward suppression of their statements. False memory organizations postulate that therapists plant inaccurate memories or elicit abuse stories from adult clients who may not be happy but who have not been sexually abused. False memory movements can be seen as mainstream backlash against women and children who have spoken up about the abuses of power within the culture and in their families. This echoes what happened with Freud's incest theory: his statements about the widespread occurrence of sexual abuse were unacceptable to the culture, which forced him to recant or be outcast. Unless we work toward a more encompassing view of sexual abuse, which includes not only the victim and perpetrator but also the culture, we will continue to "discover" and "repress" the widespread occurrence of child sexual abuse.

Process work

Process work offers several potentially useful tools for working with the widespread trauma of sexual abuse. In addition to useful approaches to working with the individuals involved, whether survivors or perpetrators, process work is developing more and more ways to work with large groups and may thus provide a means of working with widespread and interrelated cultural problems such as sexism, racism, adultism, homophobia and sexual abuse.

In process work the definition of abuse, including sexual abuse, is a based on power dynamics. According to Mindell, abuse is "the unfair use of physical, psychological or social power against others who are unable to defend themselves, because they do not have equal physical, psychological or social power" (1995: 107). According to this definition, the abuser at the time of the abuse has more power. If a person or group lacks an immediate defense, then abuse is occurring. This definition also provides insight into the aftereffects of original abuse: people who have been abused have not been in a good position either to recognize abuse or to defend themselves against it. Thus, until the culture works on abuse those who have been victimized are likely to be hurt over and over again. Women who have been sexually abused as children are twice as likely as other women to be raped, battered and sexually harassed as adults (Herman, 1992: 111). This dynamic does not happen in a vacuum—abuse victims cannot be re-victimized unless someone is willing to perpetrate abuse.

Power and rank

Process work introduces specific tools for working with power and rank in a range of situations. Power is frequenty mentioned in connection with abuse. The feminist movement introduced the idea that rape is not about sex, but about power, and Mindell defines abuse as a situation in which a person cannot defend himself or herself against another. Various factors make it difficult or impossible to defend oneself—lesser size, age, physical strength, mental capability and credibility in the world, for example, if one is a child. In two recent cases in Portland, public bus drivers allegedly had sex with developmentally disabled women on buses. One of the drivers allegedly threatened a woman with a developmental disability that if she told anyone she had had sex with him, they would take her baby away. This particular driver may be innocent, but the story is a clear example of one person having the power to intimidate another person with a threat: such actions fit the category of abuse.

Working with rank differences can be helpful for survivors of sexual abuse. Simply understanding the power and rank dynamics inherent in abusive situations can be reassuring to survivors, who may criticize themselves for not having been able to stop the abuse. Understanding that the difference in rank can make it almost impossible to react can be an relief to adult survivors of childhood abuse, as can understanding the power that the adult had in the situation. Process work with groups on power and rank differences may assist in raising awareness about power imbalances and may lead to those with more power decreasing the abuse of their higher position.

Transforming history: individual and group approaches

Process work offers a number of interventions that can enhance therapeutic work with abuse survivors. Sexual abuse survivors often experience a sense of powerlessness. Occasionally, survivors feel a sense of great personal power, which may lead them to place themselves in highly dangerous situations (Blume, 1990: 51-52). In both of these extremes, the survivor lacks the ability to direct her power usefully. By definition, the perpetrator in an abusive situation has more power than the victim. As a result, abuse survivors often associate power with abuse, and power and initiative become split off for the survivor. One of the ways to contact power, paradoxical as it may seem, is through play-acting aspects of the abuser in therapy, with support. This type of approach may help survivors to discover their own strength and to experience that power in and of itself is not abusive. Through discovering ways to use formerly split-off power, the energy that has kept a person frozen can actually become an ally which helps her move.

Abuse stories often contain frozen pieces of history—the individual was hurt, could not react, and continues to be immobilized by the event. The survivor may be aware of her immobilization, as in the case of sexual abuse survivors who endure explicit flashbacks to abuse that they remember or war veterans who have repetitive dreams of batte. Immobilization can also occur unconsciously, as in survivors who fear certain situations, places or people but have no recollection of the events that cause their terror. Many approaches to work with survivors have developed successful ways to work with conscious and unconscious memories of traumatic events. Common steps in such therapeutic approaches include recalling such events in full and expressing feelings connected with the events (see Bass and Davis, 1988; Herman, 1992; Maltz, 1991).

Process work's channel concepts can be extremely helpful in work with abuse memories. Researchers have identified characteristics of trauma memories, which include "a predominance of imagery and bodily sensation, and an absence of verbal narrative" (van der Kolk, 1988, in Herman, 1992: 38). These characteristics lead to certain difficulties in purely verbal therapies, since it can be difficult for clients to talk about events that are encoded only as body sensations or images. A process-oriented approach allows the therapist to focus specifically on the channel in which the client experiences memories, and can assist in discovering more about abuse stories that may appear initially as body experiences or dream images (see Mindell, 1985).

One woman I knew suffered from panic attacks at night. She awoke between 3 and 4 o'clock in the morning with her heart pounding, sweating and screaming, with no memory of a dream and no apparent or immediate cause for her fear. Through detailed work on her experience, including amplifying the physical sensations, a story eventually emerged. As a young child, she had been regularly awakened and molested by her father, who worked a late shift and arrived home in the middle of the night. Simply discovering this piece of information decreased her fear and lessened the number of times she woke in a panic.

Individuals who have been abused may internalize the abusers in various ways. For example, people who have been abused may be quite negative toward themselves: here the abuser may take the form of critical thoughts like "I'm no good." There are at least two parts to this system—the critical one and the one being criticized. Working on abuse in this case will probably involve exploring the relationship between those two parts. The individual may need to react or fight. If developed, the critical voice may have something important to say which may actually be useful to the person (see Straub, 1990). Through amplification and role play, process work can assist survivors in exploring internal dynamics, thus potentially decreasing suffering from internalized abuse.

Culture and abuse: the systems view

In addition to work with individuals, external, collective focus on abuse is necessary. If external approaches are neglected, the culture as a whole can continue to deny the reality of sexual abuse, thus perpetuating a cycle of abuse. Sexual abuse is a systemic problem that calls for systemic focus. In psychology the systems approach came out of family therapy, when early family therapists started seeing the interconnected nature of symptoms and family dynamics, especially in their work with people with schizophrenia (Wat-zlawick, Bavelas and Jackson, 1967, chs. 3-5). Process work has a specific kind of systems approach, which not only sees individuals as interconnected parts of a system, but sees all the parts of the system in each individual. All the elements of the system are within each individual, so the dynamics between parent and child not only happen between those two people, but within both the parent and the child.

This means that adult survivors, even if the abuser or abusers are dead or not available, can work on all aspects of the abuse, including the role that the abuser played. The story of abuse may still be accessible in the adult person and may appear in body symptoms, dreams and relationship dynamics.

Years ago, I worked with a woman in her early thirties who suffered from large blood blisters in her mouth. They appeared rapidly, within seconds, and were excruciatingly painful, making it hard for her to speak or swallow. The blood blisters started after she had stopped being anorexic and bulemic, which had persisted for the previous decade. Whenever the blood blisters occurred, she worked with them, and noticed that they appeared when she felt unfairly treated yet powerless to speak up about it. She also discovered deep levels of emotion underneath the blisters, including feelings of rage, terror, betrayal and grief.

Eventually a story emerged. As a young child, she had been repeatedly orally raped by a close relative but had been too afraid to tell anyone. As an adult, her work with abuse issues eventually led her to tell her family about the incest secret. Although the family denial remained strong, her blood blisters recurred less frequently after she told her experience. By the time she finished therapy, she was able to use the blood blisters to alert herself to all kinds of situations where she was being mistreated and needed to speak up for herself.

The type of systems view just discussed also has implications for working with the culture. For example, in the United States today, abuse survivors and their advocates are in a standoff with the false memory organizations. Each position sees the other as wrong, and there seems to be little hope for dialogue. If we take the systems view that characteristics of each side must be present in both groups, a number of options arise. In work with survivors, who often doubt their own experiences, dialogue between the inner part that believes and the one that disbelieves can be quite useful. I have seen individuals who have felt compelled by necessity to fight an outside world that wants to discredit them feel great relief at being able to explore this conflict internally. This perspective also tends to reduce the constriction inherent in an "either/or" view of the world. The false memory organizations have a valid point: while few children have been found to lie about experiencing abuse (see Crewdson, 1988), children have elaborated on stories and innocent people have been prosecuted for crimes they did not commit. Seeing the sides as parts of a system increases the possibility for working with each group, and also for eventual dialogue.

Treating the perpetrator: beyond punishment

Horrified reactions to abusive acts are both human and justified. Horror can serve to mobilize people against oppression. Unfortunately, horrified reactions can also lead us to equate individuals with their behavior and thus to avoid difficult questions of how to approach sexual offenders. The view that individuals and their behavior are equivalent has influenced much of the culture's reaction to sexual offenders and has led to approaches which emphasize punishment, usually by incarceration without treatment. Simply punishing abusers by locking them up is actually a cultural perpetuation of abuse and does nothing to decrease the occurrence of sexual abuse.

Over the past 10 years, alternative treatment approaches that attempt to decrease recidivism rates have begun developing (Freeman-Longo and Wall, 1986; Crewdson, 1988; Fjerkenstad, 1996). Process work offers several potentially useful points to treatment of sex offenders. As mentioned above, in addition to providing potential interventions for work with individual perpetrators, process work looks at the cultural context and may thus prove useful in providing approaches that go beyond the individual.

The Jungian concept of teleology assumes that all behavior has some meaningful end, which may not immediately be evident. This includes behavior that is unacceptable in the collective, such as abuse. This perspective does not support abuse and does not excuse the perpetrator from responsibility for his or her actions. Rather, it implies that perpetrators are attempting to meet certain needs through abusive behavior. Treatment involves in part discovering what lies behind abusive behavior (Fjerkenstad, 1996).

The idea of teleology suggests a radically different approach to offender treatment. The 1994 Status Report on Special Education and Student Services in Oregon shows that 30% of crimes for which people under 18 are imprisoned are sex crimes. This is an astonishing statistic since the majority of children who commit sex crimes have been sexually assaulted themselves. As children assault each other, a dangerous loop occurs, with more and more kids abusing younger kids and/or growing up to continue acting out as adults. It is important to note that the majority of children who are abused turn that violence against themselves and do not abuse others. My point here is that children who do molest other children have almost invariably been molested themselves (Crewdson, 1988: 206-208). Dusty Miller, the author of Women Who Hurt Themselves (1994), puts forth the premise that people who have been traumatized explicidy re-express their stories in abuse of themselves or others, in an attempt to reach some resolution of past abuse. If treatment professionals take this concept to heart, we will look not only at extinguishing behavior but at discovering the stories that offenders tell with their behavior. This may be especially effective with children, whose patterns of offense are not as firmly established.

The teleological approach of process work offers yet another step. In addition to seeing the stories that behavior may tell, it assumes potential meaning in all behavior. Process work offers both a theory and methods to work specifically with offenders on abusive behavior. I have been astonished to discover what emerges when offenders are able to work on their behavior in therapy. Behind an act that hurts others (if not unfolded) I have seen (when unfolded) the need for human contact, a desire for love, and the need to feel powerful.

I worked with one adolescent client who, at age 3, had been kidnapped by an uncle who tortured and molested her, then prostituted her to his drug-addicted friends for drug money. She spent her childhood under his abusive rule and escaped only by running away when she was 14. She had been in various foster homes and had ended up in residential treatment as a result of violent behavior, including setting fires and repeatedly molesting two younger foster children. She had elaborate fantasies about sexually torturing and killing the adults in her environment. I was quite afraid when I started showing up as a victim in her fantasies. With supervision, I was able to encourage her to go on with her fantasies, which she started writing down as stories. The more she felt understood in her need to do away with adults, who from early on had only severely abused her, the less violent her fantasies became. Over a two-year period, she started to feel a sense of her own power and took on a leadership role with newer clients as they arrived at the hospital. I don't know what happened to this young woman, but she stays in my mind as an example of the potential useful power expressed in violence and abuse.

Theoretical knowledge that such basic needs may drive sexually abusive behavior is not new. The critical element added by process-oriented approaches is that all behavior is assumed to have a deeper meaning, which can be discovered through working directly with individuals to discover the unique needs in the background. Oregon State Hospital, which pioneered a sexual abuse treatment program, offers a wide range of approaches to working with individual offenders, including therapy and assertiveness training. That program has recognized that sexual offenders often are unduly passive in personal and work relationships (Freeman-Longo and Wall, 1986). I am optimistic about what process work, with its detailed channel theory and teleological view, can offer to individual abuse recovery work. Process work also holds great promise for impacting society's understanding of—and collusion with—sexual abuse. Anything that has the potential to intervene in the cycle of abuse deserves further research.

Conclusions

Sexual abuse is not a problem that happens in isolation, and it is not a problem that happens once and is then over. Sexual abuse happens in an environment that allows it to continue by not truly acknowledging the extent of the problem, and by leaving victims and perpetrators alone with the issue rather than working on it as a collective difficulty. Sexual abuse creates a chain reaction in which survivors are affected in many aspects of daily life, and the collective loses the input of people who must spend a great deal of energy recovering from having been abused. The impact of abuse passes down in families for generations. Although the vast majority of those who have been abused do not go on to abuse others, most survivors are impacted in how they relate to themselves, their children, their employers, and the world.

Therapeutic approaches to treatment of sexual abuse survivors and offenders are still relatively new. Clearly, research in all aspects of treatment and prevention should continue. Process work offers a special contribution to current approaches through its focus on teleology and its useful channel-oriented interventions. In addition, it has great value for its nonjudgmental willingness to work not only with survivors, but with offenders. Perhaps most vital, process work offers a means of working with the collective, an essential component of stopping the cycle of abuse.

Notes

1. I am especially grateful to Jerry Fjerkenstad, Paula Iilley and Guruseva Mason for their detailed feedback and valuable input.

2. Children are not the only victims of sexual abuse. The next category in terms of frequency is adult women, then adult men. Rape in prisons is a particularly neglected issue. All of these issues need to be addressed and are omitted here due only to space constraints.

3. Many people choose not to engage in sex for various reasons. This differs from the survivor's need not to engage in sex because it is simply too painful. Child sexual abuse may serve to effectively limit the adult survivor's options.

4. It is important to note that many survivors also triumph against seemingly unbearable pain and have a lot to teach about life.

5. On the one hand, it may be argued that perpetrators do not deserve treatment, since other individuals who violate human rights receive punishment rather than treatment. Treatment in a vacuum would indeed be senseless. However, most perpetrators have unresolved abuse issues of their own, which need to be addressed. The approach to perpetrators also needs to take into account safety for victims. Simple incarceration does not decrease the likelihood that a perpetrator will re-offend when released from prison.

References

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Leslie Heizer, Ph.D., is an editor for Lao Tse Press. She has a private practice in Portland, Oregon and has worked in psychiatric settings and with abuse survivors and offenders for the last 11 years. Leslie is following her passion for writing as an editor and a poet.