For the purposes of this paper, incest is defined as childhood sexual abuse by a parent or guardian. Let me begin by sharing with you the ways in which I have come to learn about the processes of adult recovery from incest. My view is unique because it inextricably mixes the professional with the personal. I am a clinical psychologist with twenty years experience. I am an incest survivor who discovered, in adulthood, that I had been sexually abused as a child. My area of professional focus has been on how normal adults recover from loss. I began, with my dissertation, studying how normal adults heal from the death of a loved one. I have continued, both in my private practice and in my editorship of a bulletin of bereavement resources, to learn how normal adults heal after many different sorts of major losses.
My study of incest was thrust upon me. Personally it began when I began recalling my own childhood abuse. Professionally it snuck its way in over the past decade as the Freudian orientation to psychotherapy mercifully waned and a more humanistic, holistic one grew. With the infusion of literature about dysfunctional families that followed hard on the heels of alcoholism/co-dependency literature, an atmosphere was created in the general population which stimulated more deeply buried memories to surface. Adult Survivors Of Alcoholics support groups very quickly led to adult survivors of even-worse-things groups. Incest was one of those worse things, and awareness of it and discussion of adult survivors exploded into our professional world quite recently, within about the past five years.
In my own practice, incest emerged both insidiously and dramatically. In some cases it emerged as clients working on recovering from dysfunctional families began to recall sexual overtones to their childhoods. In other cases it was sprung upon them by their happening across literature on the topic which stimulated flash-backs. And sometimes the topic arose dramatically, as in the case of my first client with Multiple Personality Disorder. She arrived one day talking about herself in the third person and she was immediately thrown into having to deal with this overwhelming disorder, and I had to seek immediate professional supervision.
In my personal world, memory was forced upon me by reading an article about incest in MS Magazine in the mid-Seventies. I went from no memory, to recall of actual incidents, instantly. There was no transition and, at that time, no real help. I spent many agonizing months seeking help from professionals incapable of dealing with my problems until, finally, I had the good fortune to find one who both could and would. I worked with her for seven years and ended because she was leaving private practice, not because I felt healed.
Two other things happened that, by luck, propelled me and hauled me to what I now think was the final step in healing for me. One was that information about biological aspects of affective disorders reached me and I was able to diagnose myself and receive effective medical treatment. This allowed me the emotional freedom to pursue still-elusive memories; prior to treatment, such pursuit guaranteed a major depressive episode, a result I could not tolerate. And then my final step was taken when I joined a professionally led group of therapists who were also incest survivors, and I learned how to create a whole self.
This elaboration of my own final steps is relevant to my professional insights about obstacles to healing, in that I believe that the process of recovery from incest is a self-revealing one. By this I mean that it not only differs from person to person, but that it is the person's own mind and life that determine what that process will be. This makes the task of a therapist both more crucial and more dangerous. As with grief due to death, I use the term "process' with the caveat that there is no general script or pattern for the survivor to follow. The experiences of those who have preceded a survivor may be of more use than those of persons who have not had similar experiences. But there is much greater danger in generalizing how healing occurs with incest survivors than there is with those healing from a loss due to death.
But since this is a practice report, not a research report, I am going to describe the way healing has occurred in both the people I have worked with and in myself. These are adults who discover they are survivors. In the people I have witnessed active healing has begun with uncovering. This is usually the worst and longest part of healing. It begins with the admission that there is a possibility that incest has occurred, after a period, usually years, of amnesia about and denial of it. In some people this uncovering work goes on for years.
Denial is a persistent, recurring, and troubling problem during this period. The memory gaps are similar to those in other types of post traumatic stress syndrome, which is a more general way to describe the difficulties of adult survivors. Sometimes, during the uncovering work, a survivor will have no active memories of the abuse, just suggestive evidence, such as a woman who realized that she had known how to give a blow job perfectly the first time--an event that is entirely implausible if you consider it. Another woman recalled telling an aunt who was about to get married, when the survivor was seven years old, "If you're 40 years old and you've never had sex before, won't it hurt?" This thought does not occur to sexually uninitiated children.
Often physical behaviors become clues to the past. The body remembers the incest, even if the mind does not. Survivors often have a heightened fear of being touched. Sometimes this is revealed by a fear of medical procedures, such as pelvic exams or mammograms. Often there is loss of, excess of, or inappropriate libido. I have known survivors who avoided sex, those who were sexually insatiable, and those who have had normal sex lives. Sometimes memory will recur through physical activities, such as sports, yoga, dance, getting a massage. What can be frightening to the survivor is the out-of-control feelings that often accompany these apparently unwarranted physical reactions. When they happen, it is a case of a body at war with itself: feeling one thing, remembering another, or even nothing at all. And when this occurs with no accompanying intellectual memory, a survivor can become rapidly overwhelmed.
Unearthing usually takes hard work. Memories do not flow in the natural, spontaneous way that they do when one is recovering from grief due to death. There is no good time frame for this period: the process is not yet fully understood. In fact, so little is known about organic brain activity that we have no good explanation of how normal memory works, let alone memory after this sort of trauma. In this case, the adversary, the force preventing the recall necessary for healing, is the survivor's own brain. We are dealing with a person's inner battle to become conscious of that which the brain chooses to keep hidden. To me it is incomprehensible how one can decide to keep oneself from knowing that which one seeks to know, but it does happen. Uncovering seems to require active sleuthing.
During uncovering both the client and the therapist need great motivation. In every case I have witnessed, the motivation of the survivor is pain. The pain of not knowing, not remembering, has finally become too great to be managed alone. Something has occurred that has broken down enough of the brain's barriers to recall that the suspicion of incest can be entertained. At this point the mental anguish of trying to hold to opposing beliefs becomes unendurable. One cannot simultaneously believe that one was and one was not an incest survivor. One was or one was not; they are mutually exclusive concepts. But once the denial of a survivor is broken, even for a short time, the brain's barrier to recall is weakened. And when it is weakened enough, the pain becomes unbearable.
None of us are happy about the fact that hurt from our past can cripple us in the present. Most people do not even accept that as fact. Certainly a survivor who is beginning to deal with the return of feeling and/or memory will not be amenable to accepting the fact that she or he is even more crippled than they have been willing to admit. They are certain that the admission of that fact will doom them to being totally dysfunctional.
Usually this part of their healing process comes when they are so overwhelmed by feeling and/or memory that much of their daily routine has become interrupted or, at best, enormously difficult. They survived the incest by somehow displacing, burying, repressing it. They fear that they will die if they open themselves to the full force of their feelings and memories. THAT FEAR MUST BE RESPECTED because it was a valid fear at the time of the abuse. IT KEPT THEM ALIVE, both physically and spiritually, though it crippled them emotionally. It is important to remember that a child who is unable to separate from abuse will die, physically or emotionally or both, and the child that lives on inside a survivor has good reason to fear extinction.
In this way, the grief of incest survivors can be much more toxic than that of those grieving a loss due to death. The intact child did not survive the abuse, and in many cases a part of that child actually did die: hope, trust, faith, joy are examples. And it is quite likely that that part may not be able to be resurrected. No matter how complete the recovery, the surviving adult is not and never will be the person she or he might have become had the abuse not occurred or had it been dealt with while it was still live memory.
And at the start of the recovery process, the future is as dim for the survivor as that of anyone who has just learned about the death of a loved one. None of us who have worked in the field of death and dying would say to a bereaved person at that time, "You'll recover. You'll be fine!" We know of too many cases where someone did not recover, where, in fact, they became emotionally crippled, seriously ill, or died. Denial has become, over the years, part of the survivor's ego structure. One's idea of who one is becomes greatly threatened when something pierces the denial. One's very self is at risk of being destroyed. And so denial often returns as a temporary, stop-gap measure to preserve the sense of self until the survivor is strong enough to continue.
These periods are extremely upsetting to the survivor and are times when the work of the caregiver, the therapist, can be most arduous. The therapist is often not believed, both by client and by the client's world: parents, spouses, children, friends. The therapist is put into the position of having to believe that horrible things happened to the survivor for which there is no tangible evidence. This is worse than helping a bereaved person of an MIA: then, at least there was a person whom everyone agrees did exist and did disappear. Here there is no tangible evidence at all.
So the work of uncovering soon gets entangled with the work of believing. One who is a survivor has to decide whether and how to trust one's own memory, a task that is difficult because memory has already proven unreliable in terms of recall. One enters into a battle for credibility with oneself and, especially, with others. Survivors encounter enormous disbelief from others. Incest, if it is thought about at all, is lumped into the same category as rape. Rape only happens to women and bad guys, and therefore is not worthy of much notice. But with rape, though society may blame the victim, it at least recognizes that there was a crime. Incest is so heinous that it becomes incredible, implausible, infinitely worse than rape, totally unbelievable. There was a lot of concern about not sullying Clarence Thomas's reputation; practically none about the trauma which might result for Anita Hill in re-living her abuse. Incest by definition only happens to kids, and they are even less important than women and bad guys.
Because of the nature of the trauma, society is much less willing to listen to the hurt of incest survivors. After all, it is over. So when the survivor begins to accept that the abuse has happened, the survivor is put into conflict with most of society. Incest is not talked about in a daily way, though rape certainly is, especially recently with the publicity of cases of famous men accused of date rape. Society certainly does not believe that incest is a common event. Ten years ago a friend told me about her friend, a therapist who worked with abused children. She reported this therapist as saying that 50% of men were child abusers. I was skeptical at the time; ten years later I find that estimate likely to be low. I find myself shocked, even now, at writing this, for I am still caught by society's denial of the crime.
Believing that the abuse occurred is part of acceptance, and when this happens, one immediately must accept another hard truth: that one must have help from others to recover. Incest survivors do not heal fully without help. They often need the help of professionals; they always need the help of friends and loved ones. Acceptance of the past must include acceptance by others in order to end the self-blame, to undo the blame-the-victim mentality. Because the people who survived incest were abused as children, self-blame has become an inextricable part of their personality. We now know that children blame themselves for anything bad that happens to them as a way of claiming some sense of control. Even when the incest is totally repressed, the self-blame is absorbed.
So even acceptance involves a war with oneself: "It was all my fault" vs. "I was not responsible for what happened." Societal disbelief reinforces this self-blame. Only the acceptance by the significant others of survivors that the abuse did occur can mitigate this self-blame. As with a recovering alcoholic, the effects of the problem never totally disappear. Just as an alcoholic is tempted to drink, so is a survivor tempted to be self-blaming. Unless a survivor is able to build a healthy emotional environment, the effects of the abuse will be perpetuated.
Building this healthy environment is what I have come to call the creation of a whole self. Usually this means going back and rescuing the part of the self that was abandoned. And, once again, we are confronted by opposing forces: the intact child both did and did not survive the abuse. People I work with in my practice are persons I would describe as being basically mentally healthy. They are functional in their daily lives and coherent in their thought. [In the case of the client with Multiple Personality Disorder, we attempted to work together but after a time mutually agreed that we needed to find her another therapist. My style of assuming basic mental health in my clients threw a number of her personalities into great disarray.]
So in my practice, and in my own case, the person who survived the abuse has a preponderance of health. Yet the person whom that child would have become had the abuse not occurred never came into being. Some of the original child was lost, altered, or destroyed. And the adult self must go back and rescue as much of the lost child as possible. These rescues are all unique, for each child was abused in a different way, and thus hurt differently. Obviously in a case of infantile abuse, more was hurt than in a case of abuse during the teens. Abuse under the guise of affection hurts a child differently than abuse perceived as punishment. As with the death of a loved one, the loss for each survivor is unique.
Whatever the case, though, the adult must reach back to find the child. And then the survivor has to create a combination self: who one might have been if the abuse had not occurred which is integrated with the positive aspects of who one is because it did. Seeing how the abuse has become self-perpetuated is a step into freedom. At this point of acceptance, one is able to stand aside enough to see how one continues the self-blame and the victimization. And at this point, one has choice, for the first time.
This is the ultimate in self-rescue, the giving of choice to that child buried inside. Here one can close the circle of paradox. One is rescuing a child who has been hurt. The child did not cause the hurt, yet the child remains inside and perpetuates the hurt. The child needs to be rescued in order to stop this internalized form of acting out. Yet the child cannot be rescued except with the help of others, because children by definition need parents, caregivers. So the child must seek help, but the child fears help, because the original helpers, the parents, allowed the abuse to happen. Yet when the new helpers, the therapist and the survivor's significant others, actually do help, the child is finally able to collapse and admit to being weak. And then the child can be rescued and carried to the adulthood of the survivor. And the survivor, by being enabled to step outside of this circle enough to recognize this circle, begins to integrate this abandoned child into the psyche. And with this integration comes the recognition that this child, because of being a child, will always need help. And when this child is an aspect of an adult, i.e. the survivor in a stressful situation, the child/the survivor will need the help of supportive others who can perceive and articulate this circle to the child/survivor in times of stress.
It should be clear by now that, indeed, incest does hurt worse than a loss due to death. The similarities and differences between the two kinds of loss have been mentioned, but let me articulate them for clarity. There are many similarities. There is the loss of a person; in incest it is the loss of the person who might have been. There is the loss of a relationship; in incest, the perceived relationship to the parent which is destroyed when the abuse is recalled. There is the loss of love. Both types of loss can bring on tricks of memory. And in both, each loss is unique.
There is also a similarity of process between grieving and incest recovery. Neither can be rushed. One heals from each loss in one's own good time, never quickly enough! In both cases, the survivor feels diminished by the loss. In some instances of grief, there is the similarity of self-blame, as often occurs with suicide survivors. In both types of loss there can be intangible losses. In the case of incest and some cases of grief these can be enormous and include the loss of childhood, trust, intimacy, autonomy, and basic beliefs and values.
The differences between loss due to death and loss due to incest are many. One loses not only a parent; one loses also the illusion of a parent. One loses sexual innocence. Like suicide or death of a child, this loss is perceived as unnatural, but because it is also taboo, it involves more shunning by others. With incest there is always terror: the child loses the protection of a parent and there is, at some level, fear for one's life. With incest, love and violation are inextricably intertwined. With incest, there is usually enormous loss of memory, with Multiple Personality Disorder being the most extreme form.
Incest always involves intangible losses. There is seldom any tangible evidence of the abuse for adult survivors, and even then that evidence is open to alternate interpretation, as in the case of a survivor who recalled having so many urinary tract infections as a child that she was hospitalized. Her mother told her it was a result of having had chicken pox! We can unearth the medical records, but not the truth.
With incest there is usually lack of closure with perpetrator. And even if the parent is accused, which happens seldom, and the parent admits to the abuse, which happens almost never, the survivor still is left hanging, for the nurturing, protective parent either never existed or is long dead. There is not "deathbed" closure possible with the grief of adults who recall incest; by the time one remembers, it is long over and done with. With incest, part of the survivor has been destroyed. Incest is a violation not only of body but of the psyche.
Even more than with grief, incest survivors need understanding and validation, often provided by understanding therapists and/or co-survivors. And this brings me to my final topic: helping incest survivors. When working with them, I find I must be even more careful than when working with survivors of a death. With incest, no assumptions hold firm. Because we are searching for truth within a memory corrupted by denial, we can always expect surprises. There will, for an excruciatingly long time, be major body blows yet to come. New, horrible truths will surface as the survivor gains strength. For a very long time it is two steps forward, 1.99 steps back. Every strength allows a new hurt to surface. Each new hurt takes the survivor back through yet another recollection of the the abuse, the hurts, the losses, each time with greater detail.
The therapist must be able to travel with the survivors into the madness their brain has had to form just to survive. The therapist must constantly try to sift fact from fiction while never disbelieving the survivor. It is usually the case that the worst is yet to come for a very long time, each memory more excruciating than the ones before it. I hold fast to the tale of the person lost in the woods, stumbling about, frantically searching for a way out. In time, another person comes along and the first one eagerly asks the second, "Do you know your way around these woods?
The second one replies, "Yes, I do very well."
"Oh wonderful! Can you help me find my way out?"
"No," comes the reply, "but I can help you get in deeper."
We never know when or whether a person will be flooded with memories and/or feelings, but we must stand ready to help flow with the tide and do the mopping up when that happens.
In summary, I think there is a process in recovery from incest, just as there is in any other sort of healing. Much more than with grief, this process is unpredictable. But I find that when my clients or friends ask me, that I can usually articulate what is going on. Often I can make predictions. I recently told one client that I thought the recall of concrete memories would be her last stage of recovery. For her, a gifted intellectual, the memories are so deeply buried that she cannot catch more than a glimmer of them in her dreams.
I find I have developed not only a sense of where one is in healing, but also a sense of what to do next. Sometimes that is giving persons things to read, sometimes to join a group, sometimes to put the problem aside for awhile and tend to other, pressing needs. Often I will say that just coming to their regular appointments with me is enough, for by coming they stand against their own denial. It is clear to me that my work with grief and loss has helped me enormously in working with survivors. I have great respect for both the healing powers of individuals and the fragility caused by their loss. I know that healing will occur in its own good time; I also know not to abandon the person until that healing takes place. I understand the negative effects of isolation, of having one's pain discounted. And I know the importance of hope in keeping a person alive.
This is only today's view of this process. I, and others in the field, are only beginning to understand it. Incest is still to come out of the closet socially. The good news, I think, is in the field of psychobiology, where we are beginning to get a glimpse of how the human brain works. The role of medication in treating incest survivors is not yet known, not even much explored. But the physical study of the brain will inevitably help us deal better with feelings. For years I told my clients, no one has ever seen a feeling, yet we know that they exist. Well, within the past few years researchers finally mapped a feeling with a PET scanner: mild anticipatory anxiety. It was a breakthrough; now we can prove that what we knew existed really does. In the case of memory and recovery there will be other such discoveries. We know that it happens; it will be fascinating to see how the brain actually impedes its own memory. Meanwhile, all that we have learned about grief and loss can help us enormously in dealing with incest survivors.
Eliana Gil, Ph.D. Founder & Senior Program Advisor, A STEP FORWARD, Child Abuse Treatment and Training Programs, 2827 Concord Blvd., Concord, CA, 94519, 415 / 685-9670
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