Walks and Thoughts

of Michael Simes

An old Man's Tale:

Shelf

Brighouse

West Vale

Clay House

Ripponden

Cragg Vale

Todmorden

Heptonstall

Pecket Well

Luddenden Dean

Jerusalem Farm

Catherine Slack

Stone Chair

It's Just Like Home:

Hong Kong

Auckland

Rotarua

Napier

Picton

Marlborough Sounds

Kaikoura

Milford Sound

Sydney

Manly

Blue Mountains

Northern Beaches

Thailand

A City Of Revolution:

Paris

Versailles

Sacré-Cœur

Notre Dame

The Adult Legacy Of Childhood Sexual Abuse


Individual Therapy With Adult Mental Health

Referrals Where CSA Is The Key Factor

Dick Agass And Mike Simes


CHRISTOPHER
One summer's day a 23-year-old man was admitted to psychiatric hospital for observation and assessment. He had been found wandering in the city centre in a confused state, and had told the police he could not remember who he was, where he lived or whether he had any family.

Slowly, hesitantly, Christopher began piecing together the fragments of his background. He had been living with his mother and younger siblings in a large town over a hundred miles away. Because his father was a schizophrenic who required regular hospital admissions, his mother had been left to bring up a large family as best she could on her own.

Within a few days of Christopher's admission his mother visited him in hospital. He refused to talk to her, and smashed windows on the ward. Later he locked himself in the bathroom, cut himself around the genitals with a razor blade and lay down in a bath full of water. By the time he was rescued he had lost a great deal of blood. From then on he required constant supervision to prevent any further self-harm. He told the ward staff that he had been sexually abused as a child.

Christopher's continuing anguish and his determined attempts to injure himself made it necessary for him to be detained under Section 3 of the Mental Health Act and transferred to a secure ward. He was put on anti-depressants and referred to a social worker for individual counselling.

As the work got underway, Christopher revealed, over a period of several months, that between the ages of nine and thirteen he had been anally abused by an older brother. This occurred within the context of persistent physical abuse, neglect and scapegoating by other members of the family. It became clear that there were many layers of trauma and deprivation apart from the sexual abuse. The sexual abuse by his brother was terrifying, but also gratifying in that it provided crumbs of affection which no-one else in the family seemed willing or able to give. On the subject of sibling abuse, Shatzow and Herman (1989) make the telling point that in neglectful families the victim may well experience a strong empathy with the abuser who is himself a neglected child. In such cases, they say, the abuse may represent an attempt by both siblings to find comfort and nurturance that is otherwise unavailable.

Christopher claimed amnesia about much of his childhood experience, which could only be glimpsed through unwanted flashbacks. He had harmed himself for many years and could recollect taking poison at the age of nine with the intention of killing himself. The worker had a potent sense of a childhood almost irrevocably lost. As an adolescent Christopher took refuge in criminal activities and inflicted unprovoked physical violence on complete strangers. Eventually be underwent an intense, shameful reaction to this behaviour and transformed himself into a non-violent and sensitive young man, believing his life to be balanced on a knife-edge between good and evil. This dramatic 'conversion' clearly illustrates his defensive pattern - a desperate attempt, by means of dissociation, to split off all the pain and violence and to cling to an ideal self. Indeed, he created and nurtured an imaginary child inside himself, a child held in reserve, awaiting the comfort and affection it craved. In his fantasy the child within would one day be rescued by a loving family and allowed to grow up without hardship or pain. Judging by Christopher's fugue-like state on admission to hospital, this elaborate defensive system had just about been strained to its limit.

For the worker the most challenging aspect of helping Christopher was the sexual feeling which emerged in their relationship. The first signs of this appeared after two years of work. They had been discussing the abuse of Christopher by his brother when Christopher disclosed that his sexual feelings were getting out of control, and that he had been wandering around naked having strong urges towards people who looked after him. The worker was alerted to a merging of themes relating to nurture, comfort and sex.

In a subsequent session Christopher complained of headache and tension, saying that he felt tempted to do something but was afraid of the consequences. He would not expand on this verbally, but the worker was aware of Christopher giving him a look suffused with sexual yearning. Christopher began to ask personal questions about the worker's motives: what was he getting out of it? He also expressed a fear of losing the worker.

The worker could not ignore this fusion of sexual and affectionate feelings. It seemed Christopher wanted him to be a nurturing and loving parent, but also someone who could satisfy his sexual needs. (This oedipal theme later came out openly when Christopher talked of having felt sexually attracted to his mother.) On the basis of this build-up, the worker decided to grasp the nettle. He said to Christopher: 'Maybe there are times when you have sexual thoughts and fantasies about me'. This was acknowledged with great relief. Christopher said he had been steeling himself to say this for a long time.

What followed was the turning-point of the work. Christopher continued to direct a strong current of sexual feeling towards the worker, who found, to his horror, that he too was getting aroused. This produced in him a shock-wave of excitement and disbelief. Was this really happening to him? What on earth should he do about it? At one level he was pleased that someone felt this way about him, but at the same time he could not accept that such a thing was happening and felt desperate to get out of the situation as fast as he could.

When he was able to think. more clearly about it after the session, the worker realised that his reaction, with its mixture of arousal, shock, dismay and an urge to escape, was a reflection ofChristopher's own feeling-state at the time of the abuse - a highly-charged and conflictual feeling-state which had continued to dominate his adult life. The worker was also aware that Christopher desperately needed a response. In reliving this part of his early experience with the worker he needed to know whether he could love and be loved without being rejected or abused. This presented the worker with a double problem. He had to respond to Christopher in a genuine way that would positively help him, whilst at the same time sorting out his own reactions and securing his personal/professional boundaries.

In the next session he said to Christopher that he took his expression of feeling as a compliment, and that, for his part, he felt affection and concern for him and a desire to help him overcome the pain of his earlier experiences. He went on to say that he had personally chosen not to have homosexual relationships, and that he would not be able to help Christopher if he were to get involved in any sort of friendship or physical relationship with him. This was accepted by Christopher with humour, sadness and relief.

Significant changes occurred from that point in the work. Christopher re-established contact with his mother. For the first time he began to take the initiative in making relationships, and got involved in a number of social activities. He also began a sexual relationship with a woman. His self-esteem grew, and one reason he gave for feeling good about himself was that he could now exercise more control over his feelings, even when they were very strong. Christopher's problems were by no means over - past horrors are not so easily laid to rest - but a sound basis for continuing work had been established.