In the 1970s, I was a senior drug rehabilitation counselor at a special heroin drug rehabilitation program in the Bronx (NYC). My caseload consisted of about 30 hardcore drug addicts, many of them ex-convicts. As a beginning counselor, I remember meeting one of my first clients, a young Hispanic woman in her early 20s. She had been using heroin since her teens and was struggling to put her life together. In one of our sessions, she told me that her uncle had molested her throughout her early childhood. Her uncle babysat for her to help his sister, the girl's mom, who was a single parent. Very often, the uncle forced her to give him oral sex. This went on for many years. Never caught, he moved far away and the sexual abuse stopped. She never spoke about it with her mother, something that the scientific literature states is very common. Defining Child Sexual Abuse (CSA) CSA is a universal problem with grave lifelong consequences. The World Health Organization (2003) defines CSA as “the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society. Child sexual abuse is evidenced by this activity between a child and an adult or another child who by age or development is in a relationship of responsibility, trust or power, the activity being intended to gratify or satisfy the needs of the other person.” Erin K. Martin and Peter H. Silverstone (2013) list four types of child sexual abuse. They are 1) non-contact (e.g., the perpetrator exposing himself), 2) genital touching (e.g., where an individual touches the genitals of the child with his/her hands or mouth, or where the child is made to touch the genitals of the perpetrator with his/her hands or mouth), 3) attempted vaginal and anal penetrative acts, and/or 4) vaginal and anal penetrative acts. How widespread is CSA? The World Health Organization reports (2010) that globally, one in five women (20%) and one in 13 (7.7%) men experienced sexual abuse as children. There are some prevalence variations in different countries, but overall these figures are consistent worldwide. The prevalence of CSA is higher for females, children who live in poverty, and children with physical and mental disability. Children in foster homes, adopted children, single parent homes, and homes with high dysfunction including other forms of violence and substance abuse are more at risk for CSA. Nevertheless, CSA crosses all socioeconomic groups and educational levels. However, experts caution that the true prevalence of CSA is not known because CSA thrives in silence and is commonly not reported. These kids live their lives in silent suffering, being afraid or ashamed to tell someone. Another startling statistic is that in 90% of the cases, the child knows the perpetrator (e.g., parent, stepparent, uncle, sibling, teacher, coach, neighbor or baby-sitter). Israel study A former colleague of mine at Haifa University School of Social Work, Zvi Eisikovits and his fellow investigator Rachel Lev-Wiesel conducted a national epidemiological study from 2010 to 2015 on the prevalence of child maltreatment in Israel under the supervision of the Israel Ministry of Education (Journal of Child & Adolescent Trauma, June 2018). They studied more than 12,000 Jewish and Arab children. They found that 18.7% of this large sample of children from age of 12 to 17 were exposed to some type of CSA. However, in contrast to global prevalence data, Israeli boys reported higher rates of sexual abuse, compared to girls. Impact of CSA Child sexual abuse exposes victims to immediate physical trauma as well as severe and disabling emotional consequences. Rachel Lev-Wiesel identifies some of the detrimental mental health consequences associated with CSA in her paper “Childhood Sexual Abuse: From Conceptualization to Treatment,” published in The Journal of Trauma and Treatment (2015). These include post-traumatic symptoms, depression, substance abuse, helplessness, negative attributions, aggressive behaviors, anxiety, conduct disorders, eating disorders, personality disorders, dissociative disorders, self-harm such as self-mutilating by cutting oneself and in some cases psychotic episodes. Although it is beyond the scope of this article to discuss at length the complexity of the emotional fallout responses of a CSA victim, I have chosen to highlight a central and potent consequence of CSA. Rachel Lev-Wiesel describes how the brain of a sexually abused young child or teen attempts to cope with the trauma. She writes, “The brain responds to the traumatic event through various mechanisms, such as psychological numbing, shutting down normal emotional responses or activating dissociation: the subject 'splits' off part of itself from the experience.” In other words, the emotional experience is so overwhelming that in order to survive, one has to lock up and repress the fear and terror that he/she goes through when victimized. This severe sense of helplessness results in many of the victims developing some of the maladaptive behaviors and emotional reactions mentioned above. Psychotherapy is essential to help this person overcome the emotional trauma as well as dysfunctional behaviors that he/she has resorted to in order to deal with his/her own victimization. The healing process is hard and long, but there is hope for victims of CSA. I will write about treatment in Part Two. In Part Three, I will address the issue of prevention. The writer is a marital, child and adult cognitive-behavioral psychotherapist with offices in Jerusalem and Ra'anana. www.facebook.com/drmikegropper; drmikegropper@gmail.com
