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The Sexual Abuse of
Children: Shifting the Paradigm
June 11, 2002
Transcript of Fran
Henry, STOP IT NOW!
I am old enough to
step back and look into my family history—not the abuse history that I
will speak of shortly, but further back.
I found a fascinating man—brother to my great-great
grandfather. This man lived
a long life in the mid-1800’s in England. He discovered the link between disease and the raw sewage
that commonly ran in the streets and back alleys of cities.
He introduced septic systems.
Queen Victoria
knighted Edwin Chadwick for his discoveries, and he was dubbed a
“sanitary philosopher.” I
imagine him, like Dr. John Snow of Broad Street pump fame, as one of the
first public health scientists. I
have fallen in love with that term, “sanitary philosopher,” for
where but in flowery, decorative Victorian England would anyone come up
with such a beautiful title to describe someone who looked deeply into
the waste products of life?
I have wondered, too,
as I have thought of great, great Uncle Edwin—was it hard for him to
look—to really see--into sewage and to find new ways of protecting
health?
Similarly, I imagine
that many of you came into public health looking at chronic and
infectious diseases. How hard do you think it was for the early public health
scientists to look squarely at the disfigurement of small pox, polio,
tuberculosis, malaria and the like?
What gave people the strength to look into the heart of illness
and the unknown and not blame it on the devil or on God—to not run the
other way?
We have a challenge
just like that today as we look at the seeming imponderables of injury
and violence prevention. We
have to gird ourselves to look into intentional injury prevention, where
the pathogen is a person, not a germ.
To muster that courage we can depend upon the bedrock of the
public health approach—looking at the effects, positing the causes,
building interventions on data, evaluating, and disseminating findings.
I thank the staff at
the National Center for Injury Prevention and Control for the privilege
and opportunity to talk to you today.
And I thank each member of the Center’s staff.
You have given all of us a tremendous gift in formulating the
“public health approach to violence prevention.”
And though I don’t have time to publicly mention every one of
you who has helped me and this field, I want to make sure that you do
not underestimate the value and importance of your collective
contribution. As I talk to
you today during the Tenth Anniversary year of the Center, I will speak
of preventing the sexual abuse of children, but I will also reflect on
my interactions with the public health system represented by the Center,
for anniversaries call out for that kind of thoughtful reflection.
So let me go back to
a question I asked a moment ago. What
gives us the courage and the strength to look into the painful effects
of a disease or disorder and look scientifically for clues to cures? Dr.
Wanda Jones, Deputy Assistant Secretary for Health, tells a story of
years ago when she was looking at statistics on sexually transmitted
diseases and she heard that data talking to her.
As the data came in and it was separated by age and gender a
curious split happened. Girls
demonstrated a much higher rate of infection at younger years than boys.
She wondered aloud if the cause was child sexual abuse, but was
told, “We can’t call it that.”
She did not let that question die, and it fueled her interest in
child sexual abuse as a risk factor for social problems.
Sometimes the data
don’t speak; they scream. The
data we have on child sexual abuse have been screaming for decades.
Yet, when it comes to preventing these kinds of injuries, I hear
people saying—we don’t know what to do, this behavior is not
curable, it is part of the human condition, etc. etc.. The politics of
preventing sexual abuse of our nation’s youngest citizens has not kept
pace with the data.
Who can help to
advance a solution based on facts?
It is those of you sitting in this room and listening to this
talk. You are uniquely
positioned to view violence and injury prevention as one of the next
great accomplishments of the public health system. You are uniquely positioned to study human volition and
combine the results of study with action; you understand that people can
both recognize and alter unhealthy behaviors.
What a contribution you make to humanity when you do this! Please do not underestimate the power of your contribution.
Just as you have seen advances in disease control spread
throughout the world, you will come to see the strides in violence
prevention spreading globally. Your
work is that powerful, its contribution to planetary well being that
inevitable.
To help you to have
the resilience and to look deeply into issues like sexual abuse, I want
to share a piece of my bedrock and hope you will find it useful, too.
That is, to remind you of what another philosopher of science,
Thomas Kuhn, taught me thirty years ago in his book The
Structure of Scientific Revolutions.
Kuhn was a physicist but what he outlined in that book can help
any of us who are willing to explore the frontiers of knowledge.
He explained how science builds, bit by bit, and how by that
process what has been learned becomes tradition-bound.
Kuhn’s analysis showed that the steady application of the same
scientific principles, consistently applied, would inevitably bring up
anomalies. If scientists
offer theories based on those anomalies, theories that can be tested,
and if they prove true, the new theories can and will sweep away what
had become dogma. A
paradigm shift occurs. Kuhn
taught me, at a formative stage in my intellectual development, that
what appears solid and unmovable, can, with data, be completely changed.
And further, in an
essay titled, “The Essential Tension,” Kuhn spoke to scientists,
encouraging them to have patience.
He depicted the necessary and very uncomfortable conflict between
what is known in scientific understanding, and what is unknown, what
represents the future. I
imagine this very sort of tension exists throughout the CDC as you
wrestle with diseases of all sorts, but especially as you incorporate
the field of injury prevention, because until we see something as
preventable, we see it as inevitable, part of the human condition.
I know that for many of you this has been a long uphill
struggle—but your efforts are contributing to a fundamental paradigm
shift that will change the world for many children and families.
Can we shift the
paradigm on this injury, the sexual abuse of children from something
that people do not want to look at, to something that people can feel
uplifted about preventing?
I will explore this
question with you today because of the work of STOP IT NOW!, a program I
founded ten years ago—when the Injury Center was also just
beginning--to bring public health principles and methods to bear on
preventing children from sexual abuse.
At STOP IT NOW! we conduct public education programs to reach
abusers and those who know them, we conduct policy work to advance
public health approaches, and we conduct research to make public health
insights available to the professional community.
We have held the hypothesis that people who abuse and are at risk
to abuse can be reached and can change.
We have conducted formative research and plowed that learning
into program design. We
have participated in evaluating our work and we eagerly disseminate what
we have learned. We have done all of this in the true spirit of public health,
not because we have training in it, but because we are passionate
believers in the power and democracy of public health tools.
Your unique contribution to society’s well being springs from
protecting individuals by dealing with whole populations.
Let me speak to you
about sexual abuse using these steps then.
First the epidemiology. Then
program design based on formative research. Then
what we have learned from evaluation and finally sharing widely what we
know.
Epidemiology
We in this room know
sexual abuse is a problem. Polls
generally and STOP IT NOW!’s random telephone surveys specifically
demonstrate that people are aware that sexual abuse occurs.
But how fully have we let ourselves know its nature?
So—the
epidemiology. Who is abused
and who are the abusers?
People who are
victimized sexually include boys and girls who suffer violations both
within and outside the family, girls and young women in date rape
circumstances, women raped within their relationships and by strangers,
women more vulnerable because of their immigrant circumstances, girls and women brought to the
United States for the sex trade, men and women raped in prisons and
institutional settings, and the violation of elders as well.
But focusing in on
children, where STOP IT NOW!’s expertise lies, what do we know about
incidence and prevalence? The World Health Organization issued a policy statement and
press release in 1999 recognizing child abuse as a worldwide major
public health problem. WHO
cited international studies in 19 countries that reported prevalence of
sexual abuse ranging from seven to 24% for girls and three to 29% for
boys. One in four to five girls and one in seven to ten boys are abused
by the time they finish their 18th birthday. Half a million
children a year estimated by researchers, with about 100,000 disclosed,
reported and substantiated cases vetted through child protection
systems. Surely such
prevalence makes the sexual abuse of children an issue of public health.
Are children affected
by these experiences? Some
children may not suffer consequences.
But exactly how many more researchers need to publish about the
immediate and the chronic health and social outcomes of child sexual
abuse? Currently Dr. Jim
Mercy and Reshma Mahendra of the Division on Violence Prevention, Dr.
David Chadwick, Lucy Berliner and STOP IT NOW! are collaborating on a
review of the literature to demonstrate for health professionals the
links that have been found between child sexual abuse, disease and
disorder. In our search,
more than 400 studies have come to the surface.
We have benefited greatly by the work of doctors Anda and
Fellitti in their groundbreaking Adverse Childhood Experiences study.
Do you think we have
sufficient documentation to claim child sexual abuse as a major public
health problem? We are
finding links with the following: ADHD, alcohol abuse, anxiety disorder, bedwetting, blood
pressure abnormality, brain disorders, cancer, gastrointestinal
problems, criminality, delinquency, depression, diabetes, dissociative
disorder, drug abuse, eating disorders, sexually transmitted diseases,
homelessness, ischemic heart disease, intimate partner violence,
nightmares, obesity, pelvic pain, physical injuries, engaging in
prostitution, psychosomatic disorder, post traumatic stress disorder,
relationship issues, self mutilation, sexual dysfunction, sexual
victimization, smoking, stroke, suicide attempts, suicide, teen
pregnancy, welfare and poverty. I
share this list as a reminder that if we grasp the harm caused by sexual
assault and were to find a way to eliminate child sexual abuse, I know
you know we would significantly reduce many social and physical ills in
America.
There are several
ways that child sexual abuse qualifies as a public health problem—its
frequency, the nature of the injury, the wide range of associated
consequences and conditions, and the global reach of the problem.
I would like to share
my own story of abuse. I
ask you to keep in mind that I am telling my story not because I relish
talking about intimate details in public, but because we know things
will not change if we keep silent.
I was sexually abused
by my father from the age of 12 to 16—four interminably long years.
I do not know how many times—the experiences blur together and
I can’t distinguish them one from another.
If I had to, I could do a better job describing the different
locations I was abused in: in
my grandmother’s home, in a home my father was a caretaker of, in the
basement of my home, in the kitchen, in the bathroom, in my bed and
worse in my parent’s bed.
I can remember being
abused at night and having to get up and go to school the next day as if
nothing had happened. When
I was going through these experiences, I remember telling myself very
clearly that if I could simply live through them I would be okay.
The fact that I remember feeling that way is the closest I can
get to know how completely terrified I must have been.
I was facing emotional death.
Also, I understand now, after my own therapy, that my father’s
assaults against me occurred against a backdrop of much earlier physical
abuse by my mother.
No one at the time
would have described her as a child abuser—she had been raised in a
home that condoned hitting as discipline.
Many homes still do. She never hit us as we got older, just when
she was overwhelmed and isolated with four very small children.
Still I have vivid memories of her breaking a wooden spoon on my
brother and me taking many hard smacks as a toddler for no reason I
could decipher—enough to instill a deep fear of harm from someone I
depended upon.
So although my
father’s abuse occurred years later, I thought if I did not physically
die I would be okay because living through it was all that mattered.
I must have assumed that my father, who had never hit me and in
fact was the source of warmth and understanding in my early years
compared to my mother, could not be harming me as much as my mother had.
Also, I had no way to value what I already had lost by his
abuse—my sexual integrity and human dignity.
Soon after I turned
16 I confronted my father and told him he could never touch me again.
Before being 16 I had said no and had shown him my confusion,
fear, and disgust of what he did, but he had dismissed my protests.
I could finally say no with certainty because at 16 I reasoned I
could leave home and get a job and survive somewhere—somehow running
away before that was unthinkable. My
father never abused me after that confrontation and I did not run away.
I do not pretend that my confrontation of him was easy or possible for
many victims, and I do not conclude that victims should be asked to fend
off those who misuse them.
Despite my belief
that I would be okay if I lived through those assaults, what has been
the harm I have suffered as a result of my father’s abuse?
It was not so long ago that I awoke from a dream in which I had
dreamed surprise at discovering that I had become bilingual.
I had mastered English and lying--lying about how much the abuse
had hurt me. Some of us
survive in the aftermath of deep betrayal by lying about the harm.
We know the truth in stages, so that it does not overwhelm us.
But as I have come to
know my truth, not a day goes by without being reminded of its peculiar
legacy. I have had so much
insecurity and fear to wrestle with.
At the same time, I found that I took a tremendous amount of the
anxiety when I was younger and channeled it straight into developing
myself as a person—making myself as productive as I could be.
And how did I manage that in the midst of the abuse?
I modeled myself after the parent I identified with—the one who
was fantastic at projects, at deadlines and hard work, at tackling
impossible challenges: my father.
I could tell you more
stories of my father’s silencing and use of me, or stories of my
father’s inappropriate defensiveness when I confronted him with the
truth, stories that would make you hate him in an instant.
But at the next moment, I could tell you stories of his humanity,
his strength and his history that might leave you able to admire him.
And I tell you this to shed light on the complexity at the heart
of sexual abuse.
Complex, isn’t it?
I hate; I want to kill. I
love; I want to forgive. I
heal; I discover the combination of hatred and love—that of
accountability and compassion. It
is complex and that is one of the reasons why we have not solved this
problem, bad as it is, common as it might be.
When the people who have harmed are the same ones we depend upon
and model ourselves after, then we must take time to craft a solution
which stops the behavior and holds people accountable, but also holds
the whole situation in a community-centered embrace.
I wish that were all
I could say to you about my personal experience, but I want to say a bit
more. I have struggled
mightily with having an intimate relationship in my life.
It has been nearly impossible to sustain.
Ten years ago, after lots of work that taught me how to welcome
intimacy, I met and married a very lovely man.
What I did not understand is that it takes two people to have
done that healing work and it was not enough for me to be able to make a
commitment. A few years
into our marriage he was swept into a despair he could not shake.
He would tell me, and apparently, me only, that he thought he
might have been sexually abused when he was very young.
He had exhibited what we now would call “abuse-reactive
behaviors” with his friends at age seven or so.
But he could not remember what had happened; he only had waves
and waves of shame to live with. He certainly did not accuse anyone of anything.
Nor did or do I. In an extreme act of tragedy, and complicated by other
adverse life experiences, he killed himself five years ago.
Suicide is a very
terrible thing to witness. I
remain forever humbled by living through this particular hell, humbled
by knowing that some children are harmed in a way they cannot know or
put words to, or if they have words, they are too terrified to speak
them. Since I have always
remembered and had words for my father’s harm, I did not fully
understand before my husband’s suicide that some people are so harmed
they can only use behavior to express their pain.
In these years of
working on prevention, I have heard too many stories of
suicide—suicide of victims who could not heal, suicide of perpetrators
who could not face their shame. There
is far too much suicide connected to this issue and we must find a way
to stop it. If, as public
health scientists, you worked only on preventing suicide and suicide
attempts by looking at sexual abusing and sexual victimization as risk
factors, do you have any idea how much suffering you would prevent?
Listening to my story
and to me tell about my husband requires us to deal with an
uncomfortable fact. Like other sexual victims, we did not disclose or
report abuse. We were not
alone. How much abuse do
authorities know about?
Rochelle Hanson and
others published in 1999 a 12% rate of reporting of childhood rape to
authorities based on the National Women’s Study of females raped
before the age of 18. The Journal
of the American Medical Association in 1998 published an article
about boys and sexual abuse stating that it is underreported.
At STOP IT NOW! we conducted a survey of female and male
survivors from 1993 to 1999. They
told us about 955 people who perpetrated against them.
Survivors had reported the abuse when it was happening only on
nine percent of the abusers. When
we looked further into the data by decade that the abuse occurred, and
looked at the last decade of the 1990’s when many of the victims and
survivors who answered the survey were still children, the reporting
rate improved to 23%.
Improvements above
nine percent should make all of us feel good about the work done in
recent years—but shouldn’t we be sobered that still we do not hear
about at least three fourths of the abuse that occurs?
In Philadelphia, a manager in the child protection system told us
that there was sexual abuse going on her family but she would never
report it to the authorities—in other words to her own office. How can
we expect to hear from child victims or adult survivors if people in the
systems designed to protect kids do not want to use it?
Why do we expect
disclosure from children when we have such a hard time disclosing our
own personal experiences to each other?
As a society, we wait for a boy or girl to tell us that “daddy
is touching me” or “my cousin puts his hand down my pants.”
Why do we expect children to be able to tell the difference
between good touch and bad touch when so much of this teaching in the
schools is woefully inadequate or non-existent, when family members or
friends of the family perpetrate so much of the abuse?
Have you realized how children are on the front lines of stopping
the people who are intent on using them?
Why aren’t we learning about, and paying attention to, the
behavior of people who sexually abuse or who are at risk to abuse and
helping them to stop or to not start?
Could we think about
this issue of disclosure for a moment?
How hard would it be to talk about sexual abuse publicly if it
had happened to you? If I
asked each person in this room to raise your hand if you had been
victimized by sexual abuse could you do it—even though you are in the
company of colleagues who respect you?
Suppose you had some offending behavior in your past, could you
admit to it? How about if
you knew someone close to you who was a victim or an offender?
Could you talk about it?
Again, from our
survey of survivors, what did they tell us about people who abused them?
Of the 955 abusers identified by the survivors from STOP IT NOW!
questionnaires, 11 were strangers. Every other person of the 944 who abused, except seven who
were not defined, was known to the child by blood, by marriage, or being
a family friend, neighbor, teacher, religious leader.
In fact, the closer the blood relationship, the less likely would
the abuse have been disclosed to a statistically significant degree.
Of the 955 abusers, 217 were biological fathers, the highest
number of all relationships. The next highest were 111 stepfathers, 82 uncles, 79
brothers, 56 cousins, and 47 grandfathers.
Just to complete the picture a bit—of the 955 abusers, 26 were
mothers; there were no stepmothers, but there were 4 aunts, 4 sisters,
and 4 grandmothers.
From
epidemiology to program design
The basic fact that
children routinely do not disclose abuse has led STOP IT NOW! to its
focus on abusers and those who know them.
We shift the burden of prevention to adults with three target
audiences:
1) abusers and people
at risk to abuse
2)
family and friends of abusers
3)
parents of sexually abusing youth
We have conducted
research for each of these audiences, both literature review and focus
group research. Let me tell
you a bit of what we have learned. First, for abusers. Few people know
the difference between groups of offenders or the warning signs of
offending behavior. I liken
citizens’ knowledge and even some professionals’ knowledge of sexual
offending to where we were many decades ago with cancer—any cancer was
considered the kiss of death and people were ashamed to talk about it. Now if a friend tells me she has cancer I know to ask—what
kind—what stage—what is the treatment—and the like. I know how to offer different kinds of advice and support.
We have not reached this point with sexual offending, but with
your help, we could.
People who have a
primary sexual orientation to children are diagnosable as having
pedophilia. Not all people
with pedophilia will abuse. Those
who have pedophilia and who abuse, do so primarily, though not solely,
on boys. When pedophiles
abuse they usually have many victims of the same age.
The most common
category of people who abuse children are those who abuse in familial
and intimate circumstances. They
are often referred to as situational offenders.
They often abuse girls and each offender has fewer victims. Adult
men are the most frequent abusers of children.
In about 30-40 percent of incidents young people are abuisng
younger or less powerful children.
Girls and women abuse in an estimated 5-10 percent of incidents.
STOP IT NOW! has
conducted focus groups in prisons and in treatment programs with people
who are recovering sex offenders. We
have learned from them the warning signs of abuser behavior such as
seeking special alone time with children, giving children inappropriate
gifts and permissions, someone preferring children’s company while
lacking peer relationships.
In our media messages
and information brochures we offer people who are abusing the chance to
hold themselves accountable. What is the nature of accountability looked
at through the lens of prevention?
What is the role of public health on issues when a crime is about
to be or has been committed? At STOP IT NOW! we know these are critical
questions to ask. People ask us and ask rightly—“If we make sexual
violence a public health problem where is the accountability?
If I see sexual offending as a medical problem doesn’t it let
people off the hook?”
At STOP IT NOW! we
value accountability and also view understanding as a tool to healing
and to future prevention. We
help people to see that if they abuse they must hold themselves
accountable or others will hold them accountable.
We know that many offenders want to control their behaviors but
they don’t know how to. The
ones who could not care less about changing should not keep us from
learning from those who seek help.
But STOP IT NOW! has learned so much from people who have abused.
We have learned from the many hundreds of letters we receive from
people in recovery from offending behavior, from the hundreds of abusers
and potential abusers who have called our helpline, from interviews we
have conducted in treatment programs and in prison, and from people who
have abused and have spoken in public forums in the STOP IT NOW! sites.
We have heard their stories of low self esteem and ignorance,
their shame at what they have done, their fear at the fates, their
cowardice at pivotal moments in their lives, and for some, their bravery
at finding treatment and following a regimen to stay clean of their
behavior no matter the cost. Their
explanations do not excuse their behavior, but they help us to
understand it.
We have learned
public health system methods of holding people accountable by educating
them and the rest of us about risk and protective factors.
For those who will not hold themselves accountable, we have to
search for ways that we can see them and confront them, so that the
responsibility for prevention does not remain with the child.
We make the analogy to how we have learned to take away the keys
from a driver who has had too much to drink. We
all know the consequences of that driver and that car weaving down the
road, not an accident waiting to happen, but an intentional injury about
to happen.
But do people reach
out for help? We know they will because they call our helpline.
A man in his early 30’s called because he is having thoughts
and fantasies about 12-15 year old schoolgirls. He fantasizes about
sneaking into their bedrooms at night and molesting them, although he
has no access to girls at present.
He watches girls as they leave school; he takes pictures of them
and masturbates to the pictures and then in a moment of revulsion throws
the pictures away. He knows
he has a problem, He has called because he is married and he and his
wife are trying to conceive. He
is very afraid of molesting his own child.
He discloses his older brother molested him for eight years in
his childhood. He wants to
know what to do. Can we
help him stop before any abuse has happened? We have taken hundreds of these calls from people seeking
help. We know we could be
reaching many more people before the harm has happened.
I have had to wrestle
with some powerful fears in working with abusers. The first time a story
appeared in a local paper, and before I had either a staff or a helpline,
I came to work one morning to hear a voice on the answering machine,
“I can’t stop myself.” That
is all he said. Perhaps some of those same fears are coming up for you
as I talk. Fear that by
being public an abuser will assault me.
Fear that people who offend will not care if victims are hurt and
willfully abuse. Fear that
abusers will promise to change but lose sight of their commitment as
time passes. I am not wrong
to fear; but I face the fears with the stories of so many who have
genuinely sought help.
Let me touch briefly
on the sexual offenders we most often fear.
We know that our helpline probably does not get calls from the
most deadly offenders, those who abduct and murder.
When the criminal justice system stops them it is far too late.
Their behavior is completely outside the social contract and it
makes us turn away from them. But
we have not looked deeply into their histories.
A recent study, by no means the only one I have seen of this
type, analyzed the backgrounds of 16 men sentenced to death for lethal
violence in California. The
researchers found severe histories of violence in every case, family
violence, and severe physical and sexual abuse in 14 cases. Child
protection systems and public health programs did not reach them; they
did not get the help they needed when they were young.
Again, that does not excuse their behavior; it sheds light on it.
The second audience
STOP IT NOW! reaches is family and friends of the abusers.
At STOP IT NOW! we have learned the importance of the people who
surround the victim and the abuser because they can witness and take
action. It took us four years of patient work to find people willing
to be public about how they could have or did deal with sexual abuse in
their families. They spoke
of their despair at not knowing what to do as they watched worlds that
fell apart. Yet, many
people call the helpline ready to learn how to ask appropriate questions
in circumstances that concern them.
The third audience is
with parents of sexually abusing youth.
One set of parents of a boy with sexual behavior problems has
spoken publicly about the ignorance of a school counselor, trained
therapists, and professionals at a children’s hospital.
They had sought help repeatedly for problems in their family.
Because the professionals could not recognize the warning signs
of sexual abuse, the boy’s victimization of younger children
continued. We show parents
that help is available.
Working with the
language you are familiar with, what do the three levels of prevention
look like for sexual violence against children?
Tertiary prevention means sustained quality efforts in child
protection, medical intervention, and using the criminal justice system
and treatment. Secondary
prevention means attending to risk and protective factors for abusing
and for victimization. Primary
prevention means reaching all citizens on the topic of healthy sexuality
and by instilling a value of sexual integrity for ourselves and for our
children. It means
broad-scale education on risk factors.
The systematic
thinking of public health helps us to get beyond the deep emotions of
sexual violation, look at the facts, learn about who is at risk, learn
skillful ways of asking questions and intervening and confronting
situations when warranted.
Tertiary
prevention
First, prevention
through tertiary work…after the fact…a child has already been
abused…make certain that the child is protected and the abuser held
accountable either in prison or in the community with levels of
management commensurate with the risk the particular offender displays.
Sexual assault is a
crime. None of us want to make it a public health problem and erase the
crime. But the criminal justice system has not gotten the right mix of
accountability and understanding. I
am reminded of a criminal justice professional telling me that the
system was established to deal with one-time wrongdoings, not with
chronic social problems. Families
will not come forward and get help if prison is the preferred remedy.
A sex offender treatment provider told us of a situation in his
Midwest community where community notification on a father who has
molested his daughter had led to her classmates knowing about his abuse
of her. Boys in her school
had confronted her at school and said since she was “doing it with her
father, she could do it with them.”
She was traumatized and feared she would be raped.
Another boy intervened and she got away from them for the moment.
But her experience reminds us that bad interventions are not good
tertiary prevention.
A mother in our STOP
IT NOW! VERMONT program told us that when she found out her son had
molested another child she was terrified to tell people.
She said it would have been easier to tell people he was a
murderer than a molester. Something
has gone wrong here. Young people who have been abused deserve good
quality assessments, treatment, and a supportive environment.
We need to offer support for families so that they do not become
isolated.
STOP IT NOW! has
shown that good tertiary prevention means recovering offenders helping
to prevent abuse. One
example within a public health model is our Dialogue Project.
We invite a survivor, a recovering sex offender, and family
members before the public, asking them to talk about their experiences
and what they have learned. They
answer citizens’ questions—such as someone asking a survivor, “Why
didn’t you tell?” and after her answer the recovering sex offender
saying, “I chose people who would not speak.”
Such confrontations between misconception and experience prove
that change can take place in a positive and constructive public
meeting.
Most important here
is our own limiting belief that offenders will not change and that
treatment does not work. Researchers
have shown that treatment does not help the most psychopathic offenders.
Good quality assessments and treatment (the standard for care
includes components of cognitive behavioral and relapse prevention
treatment) does work for many others and the report last month by
Hanson, et al. on a collaborative database on 9,353 offenders
demonstrates considerable promise.
Not for every single person—obviously not for those who never
get good quality treatment or who walked away from it.
Does the fact that some people won’t reach out for help or
refuse help give us the excuse to not offer it—many sex offenders who
want help do not get it.
To prevent sexual
violence from happening again after it has occurred we need new thinking
on criminal sanctions, like exploring restorative justice concepts or
victim-offender mediation where warranted and cognitive behavioral
treatment available for those who need it. We cannot be satisfied with the justice system narrowly
pitting defense attorneys and their role of protecting their client’s
liberty interest against prosecutors’ needs to convict and
incarcerate. We cannot put
all of our attention into the tail end of the problem in the form of
civil commitment, prison, community notification, and believe we have
prevented abuse. And we produce a false argument when we say funding should go
to one part of the system and not the other.
Each part of the prevention continuum needs support.
Secondary
prevention
Now let me focus on
secondary prevention, on who is at risk to abuse and to be abused. I
spoke earlier about risk factors for people at risk to abuse.
These signs and others are posted on our website stopitnow.org.
People could learn about such risk factors for perpetration and be
intelligent about using them—not as checklists to harass people but as
a guide to ask questions and to learn about potentially troubling
circumstances. Further,
STOP IT NOW! is engaged in a research project with doctors Eben Ingram
and Jim Mercy of the Division of Violence Prevention and other
researchers in the field of sexual violence to identify risk and
protective factors for perpetration.
What else could
society offer? We could support employer programs that help people with
sexual behavior problems the way people get help for drug abusing or for
quitting smoking. We could
help the medical system screen people for risk of abusing behaviors and
for risk of victimization. This
piece of policy and practice work has begun in the American Academy of
Pediatrics, but other specialties could use it, too.
What STOP IT NOW!
has shown is that we could do much more. In partnership with
organizations in Vermont, Philadelphia, Minnesota and in the United
Kingdom and Ireland, we conduct social marketing campaigns to reach
adults in an abusing or potentially abusing circumstance, building
awareness about abusive behavior and what can be done to stop it.
Our programs have been evaluated, currently by the branch of
prevention, Development and Evaluation at the Division of Violence
Prevention, and results have been published in your Morbidity
and Mortality Weekly Report and reproduced in the Journal of the American Medical Association.
The key insights we have gleaned thus far from the evaluations
are that:
-
people are
aware of sexual abuse and know it is a problem;
-
people
cannot identify warning signs in abusers;
-
if people
know sexual abuse is going on, they do not know what to do about it;
-
abusers
and people who know them will call helplines.
Some will come forward for help.
On that last point,
are you aware that at the same time we wait for a child to disclose
before the system steps in, we offer no help or information or
incentives for people who are abusing or who are at risk to abuse to
come forward? No adult can
come forward in this country for help with sexual abusing behavior
without being reported. With
our focus on secondary prevention, STOP IT NOW! is working on ways to
motivate people to come forward to get the help they need before they
abuse.
Let me take a
moment and show you some media examples from NOW!’s work.
We have demonstrated
in Vermont, in Philadelphia, and in Minnesota that some people who need
help will reach out for it. We
have also taken care in Philadelphia to conduct focus groups and to work
with people in the Latino/Latina and African-American communities to
determine what messages would be most meaningful.
For the Latino community that research has led us to produce a
brochure in a story-telling format; for the African-American community,
it has lead to working with faith-based groups.
Primary
prevention
Now I will would like
to explore primary prevention. With a focus on sexual violence, such
measures would reach all citizens so that they understand about healthy
sexuality and its opposite.
The most significant
work done in primary prevention of sexual abuse has been released by
former Surgeon General David Satcher in June of last year.
I hope you are familiar with The
Surgeon General’s Call to Action to Promote Sexual Health and
Responsible Sexual Behavior. This
courageous report challenges individuals, communities and government
entities to recognize the harm caused by sexual behavior problems
broadly and to work diligently to eradicate them. This report is only
available online, but it has a far-reaching agenda that each one of us
could hold up, quote, cite and bring to life.
Adding to the
inspirational work of Dr. Satcher,
I would like to explore another way to promote sexual well-being
and that is to ask each of us to cultivate a value of sexual integrity.
I use this term “sexual integrity” to define sexual activity
that is vital and life-giving and causes no harm.
Because we have not
held a value of sexual integrity in our culture and have not been
willing to discuss the range of wholesome sexual expression in humans
from birth to old age, we have banished sexual life to places that are
not afraid to use it—the business world and entertainment media.
They have brilliantly capitalized on our silence to put sex into
everything and everywhere, not as carrier of healthy human expression,
but in its role as sales merchant. We are prey to what businesses choose
to project upon us. Even worse, our children are prey to this kind of
exploitation, to their sexual experience as commercial commodity.
We need instead to
build our strength and resilience by telling the truth about our own
vibrant and healthy sexuality. Speaking
kindly and generously about sex we would have less difficulty breaking
silence about sexual abuse that is conducted in homes and in the privacy
of intimate family life. We need to say something when we feel healthy
sexuality is publicly demeaned.
We also would be
freer to accept and to welcome children’s sexual expression as
healthy—and know the difference between healthy behaviors that are
private, and unhealthy behaviors that are kept secret.
Perhaps if we had a value of sexual integrity we could understand
that sex, when it is used to manipulate, is not acceptable in adults or
in children of either gender. Programs that teach body safety would incorporate teaching
children to not touch others in a coercive way. Perhaps with a more openly expressed understanding of
sexual feeling, we could also recognize that we may have sexual feelings
in the presence of children or in response to children, and that they
may have such feelings in response to us as adults, feelings that are
fleeting, not worrisome, and do not translate into acts.
And wouldn’t a
vital, healthy sexual integrity be a cornerstone of our own feelings of
safety for ourselves and for our loved ones?
Wouldn’t we find that a life-affirming sexuality lies deep
inside us, on a journey waiting to be taken--a journey worth a lifetime
of effort. Children would develop affirming their bodies and explore
sexuality in age-appropriate ways, the ways we see them develop in
sports, for example. Adolescents
would not get their sexual expression from the media but from within
themselves and their peers, drawing upon their healthy childhood
experiences. They would
grow up sexually intelligent and would find more latitude to talk to
their parents. Adults would
find vibrant sexual expression in all aspects of their lives and at all
ages, for sexual energy is life energy.
People would find a natural balance about sexuality, just as
people find a balance with eating, sleeping, working and playing.
Doctors would practice fully able to discuss sexual issues with
their patients, no matter the illness.
Abuse would be discussed against a backdrop of sexual well being.
An expressed value of
sexual integrity would build and support social norms that help people
to do the right thing. We
could remember that healthy, expressed values are stronger than any
control system that any one could ever devise.
Going
forward…hard work and vision
We can’t face
things as a society until we have the means to do so.
But once we have the means, we have no excuse for inaction.
With the advances we have made in social behavior problems like
curbing smoking, driving while intoxicated, and wearing seat belts and
safety helmets, we can take heart because we have the tools we need to
tackle sexual violence. We
now need the resolve to do so.
What is it going to
take to accomplish these three steps STOP IT NOW! has outlined:
intervening more assertively, getting help to adults and children
at risk to abuse, and building a cultural norm of healthy sexuality?
Perhaps it will take
what one ally of STOP IT NOW! recently said when she heard about our
work: child sexual abuse is
not my issue, but it has to be everybody’s issue.
It is not about what STOP IT NOW! can do, but what each one of us
can do, publicly and privately. That
much truth still begs to be told. The great truth of recognizing the
frequency and the harm of child sexual abuse, both too often denied and
kept silent. The truth
about who commits it, someone we might love.
The truth that we feel empathy for victims who suffer and grief
at what has been lost. And
the truth that prevention must be built into the equation, for
punishment alone will not satisfy.
That we must engage in a process respectful of all involved.
Could we perhaps be
inspired by another issue, by the terrific horror of apartheid and how
it has been mitigated by truth telling, by the establishment and
workings of a Truth and Reconciliation Commission? How would the issue
of sexual abuse move forward if we had truth and reconciliation councils
around family life?
And coming back to
the immediate—what can we do within our public health framework?
We can bring everyone to the table: victims, people who have
offended, and families. These
voices are too easily left out as we build professionalism into the
field. What do victims have
to say? What do families
really need? What do people
in recovery from abusing have to teach us?
And how about those
voices of people in poverty because you know as well as I do that the
upper and middle income groups will find a way to stop sexual abuse on
children long before such knowledge reaches children raised in poverty.
Although now I speak from a place of privilege, I was raised in a
lower income home. I am
acutely aware of the cost to children when we leave those voices in
poverty behind.
And once we have
those voices included, we could work long and hard to get funds to the
CDC’s Division of Violence Prevention.
I advocate for others to join STOP IT NOW! to find funds in
Congress so that you can take the lead on prevention--so that CDC can
promote science and practice around child sexual abuse prevention.
We could join the National Call to Action, a consortium of groups
and affected individuals working to end child abuse and neglect.
As I draw these
comments to a close, may I reflect upon what has inspired me to keep
going, despite strong resistance and doubt.
What has meant so much to me has been the support of allies,
witnesses and bystanders, showing their concern and action.
If you are a witness,
you could help by acknowledging the harm you see and letting a victim or
a survivor know, “ I am sorry this happened to you.
I want to know what I can do to prevent this violence from
happening in the future.”
If you have been
victimized, you could recognize the support system all around you and
use it. I would like to
acknowledge those who are here who have been victimized and would like
others to recognize you, too, for what you have been through. We are
sorry this has happened to you. Thank
you for sticking with it.
I also want to share
a parting story and some comments with you because those of us at STOP
IT NOW! want you to know how valuable you are as you do your work in the
world.
The first comments
are from an experience that I had in Rio de Janeiro years ago when I
worked as a management consultant for an international health project.
I was visiting a favela,
a slum, on the outskirts of Rio and witnessed children playing in and
near the open ditches of sewage on the sides of the dirt roads.
I asked the doctor who accompanied me, “Tell me, do any of the
children escape this life, this poverty?”
He looked at me in a most piercing manner, and said, “ I
don’t concern myself with the very few who escape—they are the
extraordinary ones. I pay
attention to all the ones who don’t.”
With that comment, he woke me up to my own narrow assumption that
because I had survived my childhood and had made a successful life
others could, too. He gave
birth to the true public health spirit in me.
As did my great great
Uncle Edwin I imagine you to delve into the darkness and complexity of
your work, to look deeply, so that you can help ordinary people to take
appropriate actions.
The last comments I
share with you concern how STOP IT NOW! has been inspired by scientists
at the CDC and the National Center for Injury Prevention and Control.
I will mention those who are no longer here, because againif I
talked about everyone still here, we would not have a lunch and learn
lecture, but a breakfast, lunch, and dinner day—and I have already
kept you long enough. That is, I heard former Surgeon General Elders give a
wonderful speech in 1994. Afterwards,
I introduced myself and told her about our fledgling work.
She was so enthusiastic, so encouraging.
She told me that I did not have to be a public health scientist
to do public health. That
all I needed was to be rigorous about the science.
To take STOP IT NOW!’s work seriously.
Two years after that in 1996 I called Dr. Mark Rosenberg with a
request for a brief phone meeting.
I had waited to call until our first 8 months of evaluation data
were in. His attitude on
that first call—one of curious, open enthusiasm, while wanting the
facts of what we had hypothesized and preliminarily
discovered—inspired us to believe that public health is everybody’s
health and that the prevention of sexual abuse was what STOP IT NOW! had
believed: a preventable injury, a paradigm shift in the making.
What a difference he made and you can make by appropriate
encouragement and support of public health initiatives in the community.
Thank you for your
very important work and for the privilege of your attention.
Fran thanks Alisa
Klein, Joan Tabachnick and Pamela McMahon for significant editing and
comments.
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