CHILD SEXUAL ABUSE [CSA]:
PREVENTION, PROTECTION, PROSECUTION
It is estimated that, worldwide, at least 1 in 10 girls and 1 in 20 boys
experience some form of sexual abuse in childhood. Some are abused within
the family environment, by persons they are familiar with. Some are
assaulted by strangers whom they do not know. Those who are sexually abused
as children are more susceptible to depression, eating disorders, suicidal
behaviour, and drug and alcohol problems later in life, and are more likely
to become victims of sexual assault as adults. In many countries, children
are taught how to recognize, react to, and report abuse situations through
school-based programmes designed to help prevent sexual abuse. In this
article, David Millar, a retired Consultant child and adolescent
psychotherapist, considers the problems and balances in preventing and
protecting our children from sexual abuse.,
We used to speak of ‘childhood innocence’ : these days some do not even
remember the phrase. And yet, most parents and teachers want nothing less than a
social environment that is safe, and which will allow them to move, in
“innocence”, from childhood into adulthood.
Having to deal with child sex abuse is an unwanted intrusion into this ideal
situation. So we must take on child sex abuse by both prevention and cure.
Many unwanted situations in life are better prevented than cured and the
prevention of Child Sexual Abuse would must be a paramount example. At
the same time, in most instances, the awareness of a need for prevention usually
follows on from the anticipation that there is a need for it. that a difficult
set of circumstances is approaching. Whereas this might be more easily
recognised by adults on the outside of a potentially abusive scenario, it is,
unfortunately it is so often not the case for a child experiencing the same
said scenario from the inside. Herein lays a significant problem. The
experience of the child in such worldly matters is not as extensive as that of
The incidence of intrafamilial CSA vs the incidence of extrafamilial
extrafamilial abuse is reported differently by different researchers depending
upon methodologies employed. and Some put the incidence higher in one group
than the other. Experientially, however, In the perception of most clinicians
come across intrafamilial abuse (incest) is much more frequently noted than
extrafamilial or paedophilic abuse. However, their general experience points
towards the opposite.
We are familiar with the widely used shared phrase ‘stranger danger’ to alert
children to the risks sometimes associated with over-familiar strangers.
However, but the opposing notion of ‘family danger’ is harder to comprehend.
The phrase is not so ‘catchy’, it is less and more difficult to summarise under
an attention-grabbing phrase. Freud, of course, pointed out that incest was a
near-universal taboo - so whether or not there is a natural inhibition, there
is, certainly, a social or cultural prohibition against sexual relations within
Is this perhaps why different researchers produce conflicting estimates of the
incidence of interfamilial CSA and extrafamilial CSA? And is the proper
response to the former the proper response to the latter?
Further, clinical experience shows that the closer the dependency between the
abused and the abuser, the more harm is done to the child.
What protects children overall, from extrafamilial CSA is, of course, is their
natural wariness of anyone they have not met before or anyone (child or adult)
who might impose on their personal space. This natural wariness develops from
around the age of six months and to a greater or lesser extent remains with us
However, accompanying and complicating such wariness is the child’s innate
physical and psychological attractiveness to adults not to mention their
(child-like) seductiveness as a life-affirming, important, survival technique.
In this short document, article I would like to concentrate on the prevention of
sexual abuse in children where the perpetrator may be known to the child and may
be a trusted or loving figure in their life.
With ‘stranger –danger’ s, we have to apprise teach our children of about
approaching a kind of danger of the kind which they may already sense or know
about. have their own sense But with family members, arming the child against
such dangers is much more difficult. We need have to instil guardedness
against persons towards those who are already intimately attached to them.
In the mid-nineties, Mervyn Glasser’s study of the childhood experience of
adult sexual abuses, concluded that the most damaging corruption of
relationships was that between the mother and her son.
There is an inherent problem in this. Although “stranger danger” is easy to
understand, “intrafamilial sex abuse” has no similar catchy phrase, such as
“domestic danger”. These are two different and opposing problems. The latter
certainly It does not lend itself to slogans nor does it fit comfortably with
competing notions of closeness, bonding and attachment.
So is it sufficient to teach should we simply be apprising our children – all
children – of the possible risks that may be posed by a wide range of adults or
even older children who are their ‘friends’ – including those with whom they
have familial relationships of love and affection?
What has become common practise in many households with young children is for
parents to indicate to their children which are the acceptable places on their
body for friends, siblings and parents, say, to touch and what which are those
places that the child should mainly be touching themselves - when they are
bathing for example.
A child will normally develop a passionate relationship with the parent of the
opposite sex. That parent must acknowledge and respect the child’s wishes
without responding to them in a self-indulgent or abusive way.
In other words, In terms of protection, should we simply be enhancing aspects of
ordinary family life or should we be going further and actually specifying the
types of risk that the child should be alert to - such as genital massage or
penetration? And where does this leave natural hugging, kissing, stroking and
bodily playfulness that is a joyful and rightful part of family closeness?
Prevention of CSA within the family does not lend itself to easy answers.
Perhaps parents must learn more and children, when capable, should be taught
THE PROTECTIVE FUNCTION OF THE PEER GROUP.
By school age, of course, preventive measures can, in some instances, be more
easily conveyed as the peer group as a whole is being addressed using
standardised alerts or warnings although what constitutes age-appropriate
warnings are still being debated.
The Internet can also act as an auxiliary peer group. Social media, acting
responsibly, can help children discuss child sex abuse and childhood sexuality
However, government intervention to encourage openness may have its dangers.
The government’s recent media campaign to alert ALL adults to ALL suspicions
connected to ANY child, would be a case in point. Such campaigns can do more
harm than good by making a range of everyday situations seem to be a potential
risk and a range of, otherwise healthy, child experiences presentations open
Addressing child sex abuse is not a simple matter. We risk going from doing too
little to doing too much; and in doing so may find, paradoxically, such that
children become, paradoxically, under protected by being over
protected. Action by adults is not enough. There must be input from
children in reporting abuse.
That our children need to be protected from a variety of life’s misfortunes is
obvious but we as adults or parents cannot always protect them from foreseeable
and unforeseeable consequences in life so, instead, how can we teach them to
protect themselves? It may be useful to detail some of our history in this
In the 60s and 70s child physical abuse was being acknowledged openly for what
seemed like the first time. For example the NSPCC opened its first research unit
in North London aimed at drawing attention to child abuse. However, but it was
named: The Battered Baby Research Unit, for, at that time, this as
that appeared, at the time, to be the main risk to infants and children. The
‘battered child syndrome’ then gave way in the 70s to ‘non-accidental injury’ or
Of course, historically,Historically, tales of child expropriation and
exploitation were common enough (e.g. Oliver Twist) but that was ‘in the past’
and modern families’ views evolved into a wholly different attitude to
child-rearing and the place of ‘childhood’ in a contemporary setting. But just
as we were beginning to acknowledge the physical mistreatment of children within
families, in the 60s and early 70s, evidence for the sexual maltreatment of
children, sexually, came to the fore. It was in the mid-seventies that Brendan
McCarthy, a Child Psychiatrist and Psychoanalyst, then at The Tavistock Clinic
and latterly at The Portman Clinic, was interviewed on early-evening television
about his (and others’) growing experience of referrals for child sexual
abuse. He said this was becoming a major problem. That TV program subsequently
attracted the largest ‘mailbag’ (in the days before emails) that it ever had.
Women (mainly) of all ages but with a preponderance of women in their 60s, 70s
and 80s ‘found their voice’ for the first time and were able to talk openly (to
a degree) about their long-kept secrets of being sexually abused as children.
The lid on CSA was lifted . and Society’s struggle to control and contain it is
with us still.
Publicity, in itself, provides much of the ‘oxygen’ needed to alert society to
the problem and produce the sort of social and legal constraints that we are now
familiar with. , to wit, the
The setting up and preponderant use of ChildLine, for is one such
example. Nonetheless, the problem of child sex abuse continues - and openness
and public acknowledgment alone is not enough. What comes next? Self-reporting
is given a great deal of attention in the media and in our schools so that
children and adolescents feel more able to report or ‘disclose’ incidents of CSA
to (primarily) those in authority. I will mention in passing the oft-reported
‘circularity syndrome’of CSA whereby children who are abused, later become
abusing adults. This is an aspect of the problem that seems to (re)occur no
matter how much is publicly aired about it.
This pattern of first So, teaching children ‘safe areas’ of their bodies, then
making them socially aware and encouraging open discussion leading to easier
disclosure would all seem to be appropriate and effective means responses by
responsible adults to protect children and help them to protect themselves.
An interesting development, emanating from an increased confidence in discussing
CSA, departure, here, from the emphasis on adults to protect children or
children to protect themselves, is the phenomenon of peer reporting.
Peers, as in classmates and friends, are remarkably prescient when it comes to
assessing those in their own age group who may have mental health needs.
Furthermore, they often prove to be and just as knowledgeable about reporting
child sex abuse – and more effective in measuring the effectiveness of treatment
There are obvious reasons for research studies, of course, to have been
resistant to using child-subjects. for obvious ethical reasons but Children
are much more likely to be open with their peers than with adults. Consequently,
I suspect that many peers might ‘know’ which of their friendship group is being
sexually abused before many adults would but this would be a difficult area to
Another, seemingly inherent, aspect of protection needs to be addressed. It
although it is probably the most complicated of all. It and that is the
inability of some (adult) individuals to refrain from acting out their sexual
fantasies towards children. I mentioned one aspect of this problem, above, when
I referred to the repetition- compulsion, or ‘circularity syndrome’ as it
were, for certain individuals, apparently, to continue to ‘do unto others that
which has been done unto them’. Those who have been abused as children may go
on, as adults, to abuse children.
This ‘circularity syndrome’is only one of many causal factors in this regard
which seems resistant to change despite widespread public awareness. This, even
though At the same time, there is some emerging evidence that psychotherapy for
potentially abusing adults (e.g. the Dunkelfeld Project in Germany and anecdotal
evidence in Britain) can and does inhibit or prevent some, otherwise, child
abusers from enacting their sexual fantasies toward children.
Freud may be credited as the first to highlight, what was for him, observably
and psychoanalytically, the reality that each new baby is a sexual being from
birth. We all have to live with the sexual aspect of ourselves from birth,
with the hope and expectation that we adapt appropriately at each stage of
development. But it does leave open the argument, as some child sexual abusers
have stated in their defence, that certain children may be capable of sexually
enticing adults. Conversely, being aware of a child’s attractiveness is what,
paradoxically, makes their appeal even more innocent in the eyes of a
thoughtful, mature adult. In other words, there is a natural in-built method of
mutual appeal and repeal which balances out growing up and growing old.
Nonetheless, we need to build on external restraints (public awareness) and
internal restraints (psychotherapy) where inherent conflicts remain.
Increased awareness of the dangers, and the different forms, of CSA should lead
to a better awareness of the signs of CSA, with consequent ability to put a stop
to it. Such increased awareness may alert other family members to sexual abuse
being committed when it occurs within the family. Clear rules should be implicit
– or even explicitly in some cases – and such rules should be seen to be never
However, we should consider further how the State should intervene to further
help our children, by stopping CSA in a more general fashion.
Finally, let us consider the question of prosecution or punishment which arises
when a child’s story is heard, believed and proven in a court of law. If someone
one is robbed and the robber caught, the victim is you are unlikely to feel
any sense of guilt or responsibility for their crime – even though, for
example, a mobile phone was left on display in an unfastened handbag.
However, this is precisely what often does happens when, say, a child is
molested or penetrated by a close, otherwise responsible, adult. The child
frequently, if not invariably, feels confused and complicit. This ambiguity can
be compounded by a ‘successful’ conviction, for the especially if it results in
the incarceration may be of a significant adult in the child’s world. Who then
is being punished if the (child) victim feels more guilty that the (adult)
The issue gets compounded further when the child may feel not only a confused
inner sense of injustice but also an actual external one. I recall a patient
who, at age thirteen saw a TV programme on incest. The following day, her
friends were talking about the programme in the playground and one asked,
incredulously: “How could you have sex with your father?” To which this young
woman replied: “I can, I do it all the time.”
Her disclosure led to her father being sentenced to three years in prison and
the girl was referred for therapy. Not too far into her therapy she announced
that her father was due to be released shortly and, as she would be sixteen by
then, she intended to leave her therapy and resume their sexual relationship
when he was out of prison as it would now ‘no longer be illegal’ and she ‘still
loved him’. This illustrates one further example of how complicated the
development of internal and external relationships can be in this area. [N.B.
At a subsequent meeting of professionals parole conditions were placed upon the
father not to go near his daughter.]
Prosecutions in this area are fraught with additional complications such as
sexual activity between an adult and child. This usually takes place in private
or in ‘secret’, away from the presence of witnesses. During preliminary
investigations, or if it reaches court, it becomes the child’s word against the
alleged offender and the truth often cannot be decisively determined.
In other instances, a ‘successful’ prosecution can sometimes lead to the
breaking up of a family home and may have the effect of piling more guilt on an
already fragile child’s conscience. It should come as no surprise that
successful CSA convictions are fraught by these sorts of complicating factors.
Attractive though the ideal of “childhood innocence” is, it is the lucky child
who maintains it throughout childhood.
“Childhood innocence” is where it all begins , but the means of guiding the
child from such innocence to the realities of adulthood may need to destroy
that innocence. Children need to know the dangers, both intrafamilial and
extrafamilial. They need these rules of life in the same way that they need to
know the rules for crossing the rod.
However, we must always remember that we are dealing with children – and their
needs, and indeed rights, must come first. Prosecution of sex abusers may seem
attractive to the adult mind, it may, however, have a detrimental effect on the
child. It may destroy what little innocence is left in the child.
Prevention is best achieved through education and openness about the problem.
Children should be taught that there is no shame in being sexually abused and
that they should talk freely to their peers and parents if it occurs.
Prosecution of an offender should be handled in a fashion that might, in some
way, return the victim, the child, to the state of innocence that the offence
David Millar Consultant Child and Adolescent Psychotherapist (NHS) [ret’d]