Child Abuse Trauma

Child Abuse Trauma:
Explorations in Psychology & Metapsychology

Stephan A. George

When one thinks about the issues of child abuse, thoughts usually go to sexual abuse. This is, perhaps, the result of the exposure the media gives to such cases as opposed to that given to other types of child abuse trauma such as physical and psychological abuse. Briere (1992) takes us deeper into these possibilities and into abuse trauma from neglect and neglect due to substance addiction. My knowledge of child abuse trauma comes from the popular culture, not the research and scientific literature. Briere (1992) manages to put in perspective the many things I have read and seen in my life. He provides a framework that clearly delineates the facts, the impacts of abuse, and the treatment of it. My own response, as I read, was a frequent nodding of my head and copious underlining of his points. When I had finished the assigned reading I was left with feelings of dread for the survivor of abuse; I was overwhelmed with the pervasiveness of abuse as exhibited in the statistics. Most of all, I was left with a feeling of futility. We’ll come back to that sense of futility later.

John Briere and Daniel Stern

Briere (1992) captures the plight of the traumatized child when this trauma occurs during such sensitive and critical stages in his or her life:

…when assumptions about self, others, and the world are being formed; when their relations to their own internal states are being established; and when coping and affiliative skills are first acquired. (p. 17)

In my reading of this, I immediately saw parallels to the infant development work of Stern (1985) where he describes the developing senses of self in the first three years of life. The senses of emergent self and core self—the earliest stages elucidated by Stern—mirror the establishment of the child’s internal states as Briere describes them. Stern goes on to explain that these senses of self lead to the formation of the sense of intersubjective self, that domain of relatedness to self and others. These domains or senses of self have an incipient development stage where “an event occurring early will have a greater impact and its influence will be more difficult to reverse than an event occurring later” (1985, p. 32). All of this is happening at ages less than one year. This seemed out of synchrony with much of what I was reading in Briere’s work (1992) where the emphasis is on trauma suffered later than these early years.

Stern further describes the final stage of early infant development, that of the sense of verbal self. This is a point, at about 15-18 months, where language begins to arise in the infant and “children begin to imagine or represent things in their minds in such a way that signs and symbols are now in use” (1985, p. 163). This is still quite a young age to correlate to child abuse trauma. But Stern makes an important point: language is “something to be negotiated between parent and child” (1985, p. 170). If abuse is occurring during this ongoing development of the sense of verbal self, then the caretaker is adversely affecting, even manipulating, the child’s understanding of the meaning—the signs and symbols—of the abuse being committed. As Briere states that “being repetitively told as a child that one is ‘stupid’ or a bad person, for example, would appear to be an especially efficient path to the development of later self-derogatory and depressive cognitions” (1992, p. 31).

Briere and Stern come into confluence at this point. When the child is told, for example, that fondling is normal and that telling others is bad, the negotiated “meanings” can throw the child into a state of dissociation. What is being taught within the abusive environment flies in the face of “meaning” as taught to the child in the larger world around him or her. While I cannot develop this point to any greater detail in this paper, I find the continuity between this theory of infant development by Stern and the ongoing impact of child abuse trauma as described by Briere to be an interesting point for further exploration.

Abuse in Metapsychology

Briere speaks to treatment of abuse:

Although support and caring are generic components of all good psychotherapy, individuals with difficulties in the self domain especially require a stable, positive environment in which to work. (1992, p. 114).

This fully supportive approach is also well stated by Gabbard (1992) in his descriptive illustration of the expressive-supportive continuum of psychotherapy (p. 97). Empathic validation, advice and praise, and affirmation of the client (pp. 98-99) become the therapeutic tools of choice at the supportive end of his continuum, what he further refers to as the “transference cure” (p. 101).

Gabbard brings Freud’s ego psychology together with object relations theory and Kohut’s self psychology to develop this continuum. While elaboration of these theories offers nothing to the client, they are of immense value to the therapist who can draw upon them to better understand how supportive treatment of the client might proceed.

Gabbard appears to omit Jung, but Kalsched (1996) presents a compelling picture of the origins and mechanism of childhood abuse in his description of the “attacking mind” (1996, p. 92). It can only be helpful when , in the therapy of the abuse survivor, the therapist understands that a good deal of the pathology arises from a split in the affected archetype. As Kalsched (1996) indicates:

We might say that one pole (mentation) attacks the other (affect), thereby destroying the psychological structure and leaving an already fragile ego further undernourished. Trauma both stirs up volcanic affect and at the same time severs it from its image-matrix. (p. 92).

This metapsychological explanation helps define the dissociation resulting from childhood abuse trauma and presents, strongly, a case for a supportive approach to the treatment of the abused survivor.

Shengold (1989) presents us with a recapitulation of the term “soul murder” from the point of view of Freud and his well-known case study of Dr. Schreber (1911/1963, p. 107). Shengold’s literary approach follows much the same vein as Freud’s. His use of this term brings a chilling aspect to one’s thoughts of child abuse trauma. And, perhaps most disturbing, is this passage:

Of course a touch of soul murder can be an everyday affair. Every life contains occasions when one is the victim or the perpetrator of an assault on a person’s right to a separate identity and a full range of human responses. Few people are without at least moments of beastliness. We are all capable of behavior so bad that we find it necessary not to register what has been said or done. (Shengold, 1989, p. 23)

Freud, as summarized by Shengold, seems to instill a sense of the sacred as it relates to rearing the child. There is a tremendous burden of responsibility shouldered by the parent. If the parent is in denial about what has or is happening, it is a simple matter for that parent to pass that denial along to the child. The caretaker’s responsibility is enormous. When the abuse survivor ends up in the therapist’s consulting room it is this inheritance of denial that must be dealt with, this inability of the survivor to distinguish between fantasy created by the caretaker and the reality of the abuse that occurred.

Both Jung and Freud recognized the impact of child abuse trauma on the patients of their day. Briere and Stern confirm and elaborate the consequences of such trauma on the adult survivor. As I said earlier, I find a sense of futility arising in me as I read of the treatment of adult survivors of abuse, be it, sexual, physical, or psychological. Lipinski (1999) points out that current law expands the definition of child sexual abuse to include children up to the age of 17 (p. 40). This emphasizes to me just how long some types of abuse might be occurring, from Stern’s development of the senses of self in the first years of life, right through puberty. In the context of this thought, how can any therapist ever possibly think that a therapeutic cure can be affected by length of treatment anything less than the rest of the life of the client? To throw up one’s hands in despair is negligence. To admit to the impossible task ahead of “curing” the adult survivor is one’s only course of ethical action. Admitting the possible futility of treatment—doing it nonetheless—may be the mark of a truly dedicated abuse therapist.

Gabbard (1994) makes a statement that should resound in the mind of every therapist who must deal with child abuse trauma:

For small children to believe that the world is a malevolent place in which they are subject to random acts of violence is profoundly chilling. (p. 301)

It is soul murder with which the therapist must contend. If the murder is incomplete, perhaps the therapist has a chance to restore some semblance of soul life to the adult survivor. That is obviously Briere’s contention as, I’m sure, it is the contention of every well-meaning abuse therapist. If no attempt to revive the soul is made then the cycle of parent-child denial continues uninterruptedly, destroying not only the individuals but also the very fabric of society and culture.

REFERENCES

Briere, J. N. (1992). Child abuse trauma : Theory and treating of the lasting effects. Newbury Park, CA: Sage.

Freud, S. (1911/1963). Three case histories. (Rieff, P., ed.). New York: Collier Books.

Gabbard, G. (1994). Psychodynamic psychiatry in clinical practice (2nd ed.). Washington, DC: American Psychiatric Press.

Kalsched, D. (1996). Jung's contributions to a theory of the self-care system. The inner world of trauma: Archetypal defenses of the personal spirit (pp. 84-99). New York: Routledge.

Lipinski, B. (1999). In the best interests of the patient: Ethical and legal issues in the practice of psychotherapy. Ventura, CA: Pacific Meridian Center.

Shengold, L. (1989). Aspects of soul murder. Soul murder: The effects of childhood abuse and deprivation (pp. 14-23). New York: Fawcett Columbine.

Stern, D. N. (1985). The interpersonal world of the infant. New York: Basic Books.