title: The centrality of victimization. Regaining the focal point of recovery for survivors of child sexual abuse.
abstract: Psychiatrists have tended to be reluctant followers rather than leaders in the proliferation of concern for child abuse that has developed over the past 25 years. By discounting the relevance of child sexual trauma, psychiatric clinicians and theoreticians overlook not only the therapeutic needs of many survivors but the opportunity to reconceptualize the role of trauma in the etiology and treatment of conditions presumed to be incurable. Present controversies over child sexual abuse are mirrors of past misadventures with uncovering. Since 1860, child abuse has been discovered and then discredited every 35 years by the most visionary clinicians of the day, each faced with the alternative of denouncing the discovery or succumbing to scorn and disgrace. The history of child sexual abuse, whether viewed by parent via child, therapist via patient, or adult survivor via the child within, is one of unimaginable pain and betrayal masked by adult distancing, disavowal, victim blame, and identification with the aggressor. The lurid emotional imperatives of the trauma itself have no place in a just and fair society, and they resist translation into the rational, objective language and concepts of behavioral science. The subject of child sexual abuse is itself so passionate and so paradoxical that it provokes polarized dichotomies at every level, leaving indifference and avoidance as the only hope for serenity. The active nesciance, the determined insistence on not knowing, that pervades every aspect of child sexual abuse encourages the most authoritative scholars to be the most repressive of radical discovery, especially if authority has been achieved as a reaction against youthful vulnerability. Every clinician facing a survivor of childhood sexual trauma faces an assault on personal comfort and authority, just as each patient in that encounter risks intimidation and disgrace. The connections between childhood assault and adult adjustment will be missed unless the therapist can find an unprejudiced path toward mutual acceptance. The promise of genuine understanding and radical resolution of the effects of child sexual abuse is dimmed on both sides by a history of abandonment in the face of scornful, punishing authority. Freud's concept of the unconscious as the arena for successful psychotherapy, his sense of the patient as a normal, healthy individual incapacitated by the effects of buried trauma and his initial optimism for radical recovery from post-traumatic handicaps were soundly derived from his clinical confrontations with child sexual abuse, as were Ferenczi's parallel contributions 35 years later.(ABSTRACT TRUNCATED AT 400 WORDS)
authors.affiliation: UCLA School of Medicine.
authors.forename: R C
authors.initials: RC
authors.lastname: Summit
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology*; D005260:Female; D005619:Freudian Theory; D006801:Humans; D007179:Incest; D011575:Psychoanalytic Therapy / Q000379:methods; D011613:Psychotherapy / Q000379:methods*