De Zoysa, P. (2000-2001). Psychological
consequences of childhood sexual abuse: issues in the Sri Lankan
context. Sri Lanka Journal of Social Sciences, 23 & 24, 17-32.
This paper is concerned
with the psychological consequences of childhood sexual abuse in the Sri
Lankan context. It discusses the status of the literature on childhood
sexual abuse in the country and goes on to present childhood sexual
abuse as a traumatic incident that is characterised by four commonly
seen manifestations. Each of these characteristics are explored and
illustrated with case vignettes that serve to highlight the salient
points. Finally, the papers elucidates the main barriers in Sri Lanka
that need to be surmounted in order to have an integrated service
delivery in the care of the sexually abused child, and, presents some
suggestions to enhance such existing services.
Most of
us find the idea that adults may be sexually attracted to children, so
repulsive, that we prefer not to think about it. Indeed, only in the
past decade or so have sexual abuse of children been considered a major
mental health problem.
Childhood sexual abuse in Sri Lanka
A person under the age of
18 yrs. is legally considered to be a child. According o the legislation
of the Sri Lankan government, the following are considered to be
sexually abusive acts against a child:
- Offence of causing seduction of a girl (Section 11 of the Vagrants Ordinance No. 4 of 1841)
- Grave sexual abuse (Section 365 B of the Penal Code (Amendment) Acts No. 22 of 1995 and No. 29 of 1998)
- Sexual exploitation of children (Section 360 B (1) of the Penal Code (Amendment) Act No. 22 of 1998)
- Offence of incest (Section 364 A of the Penal Code (Amendment) Act No. 22 of 1998)
- Offence of prostitution (Section 11 of the Vagrants Ordinance No. 4 of 1841)
- Offence of gross indecency (Section 365 A of the Penal Code (Amendment) Act No. 22 of 1995)
- Offence of unnatural acts (Section 365 of the Penal Code & Section 365 of the Penal Code (Amendment) Act No. 22 of 1995 )
- Offence related to obscene publications and exhibition relating to children (Section 286 A (1) of the Penal Code (Amendment) Acts No. 22 of 1995 & No. 29 of 1998)
The
sexual abuse of boys by adults is common in Sri Lanka, although Sri
Lankan society has been somewhat slow in acknowledging this fact (De
Silva, 2001). One early example of childhood sexual abuse of a boy was
documented by Alles (as cited in De Silva, 2001). The case was that of a
tailor, named L. L. Jayawrdene, who used to lure schoolboys in to his
fitting room with promises of a motor bike ride. One day, the offender
had lured a fourteen-year old school boy, who had later rejected him,
for which, the latter had murdered the boy with an electrically
detonated parcel bomb. The tailor was sentenced to death by hanging.
According
to De Silva (2001), in the latter half of the last century, paedophiles
and child sexual abuse was hardly heard of and sexual actions between a
child and an adult was termed homosexuality and the victims were
considered as criminals. De Silva (2001) further goes on to state that
the book tilted Colombo by Carl Muller (as cited in De Silva, 2001)
provides insights into the occurrence of sexual abuse of boys in the
Colombo society. According to De Silva (2001), Colombo, which is written
in a semi-fiction fashion, points to several instances of sexual abuse
of boys, reflecting such acts in Colombo's "burgher" community and the
"local" community during the 1930's and 1940's.
Since
the boom of the tourist industry in Sri Lanka, much emphasis has been
on the sexual abuse of Sri Lankan children by foreign paedophiles. The
reader is directed to De Silva (2001) for an excellent review of
literature pertaining to this matter.
According to Nizam
(as cited in De Silva, 2001), even though the medical profession and
the public did not widely recognise childhood sexual abuse even in the
recent past, in the period 1994 to 1995, police data had shown a
significant number of reported sexual abuse incidents, including, 179
cases of abuse, incest or intimidation and 172 cases of sexual violence
against a child. De Silva (2001) further goes on to state that,
suprisingly, the above data on child prostitution, child pornography
and encouraging the seduction of a child indicates the child as an
offender rather than a sexually exploited victim.
In a
study by De Silva (as cited in De Silva, 2001), an anonymous
questionnaire on the incidence of childhood sexual abuse was
administered to 899 university students. The same questionnaire was
administered to 818 university students who heard a lecture on child
abuse prior to completing the survey. In the initial study, 18 percent
of males admitted having being sexually abused during childhood. Five
percent of the females also reported having being abused. In the group
that was given a prior lecture on child abuse, 21 percent of males and
11 percent of females reported childhood sexual abuse. In this study, a
majority of the males had been abused either by a relative or a
neighbour. Other abusers included brothers, teachers and priests. Older
women had abused nineteen of the boys. A majority of the females had not
divulged the abuser, suggesting that it may have been an immediate
family member. Females who heard the lecture on child abuse were more
likely to divulge the identity of the abuser than those who did not hear
the lecture. In the initial study, 6 percent of the males admitted they
had sexually abused (or were still abusing) other boys and/or girls. A
significant finding was that 71 percent of these males reported having
been sexually abused during their childhood. In the group of students
who heard a prior lecture on child abuse, an alarming 12 percent of
males admitted having sexually abused a child at least once, and 64
percent of them reported having being sexually abused as children.
Another
study conducted at the sexually transmitted disease clinic of the
Teaching Hospital at Karapitiya, found that individuals who admitted
promiscuous behaviour reported a very high incidence of childhood sexual
abuse (De Silva, Rubesinghe, Jayasekera, Wijayasooriya, Hewamanne &
Ginige, 1997). In this study, commercial sex workers reported the
highest incidence, at 40 percent. When the total promiscuous male sample
of fifty was considered, 21 per cent admitted paedophilic activity,
while 64 per cent of these child abusers had been sexually abused as
children.
In conclusion, the above data indicate widespread childhood sexual abuse in Sri Lanka, especially among boys.
Childhood sexual abuse as a traumatic event
According to Terr (1991),
childhood trauma could be defined as the mental result of one sudden,
external blow or a series of blows, rendering the young person
temporarily helpless and breaking past ordinary coping strategies.
Thus, we may view childhood sexual abuse (which is one type of childhood
trauma) as an event that makes the child helpless and make his* current
coping strategies quite ineffective in dealing with the incident(s).
The trauma begins in the outside world of the child and once the
event(s) take place, a number of internal changes occurs in him. These
changes last - often to the detriment of the child.
Research
on mental conditions brought on by traumatic life experiences in
childhood (such as sexual abuse) presents a wide range of findings.
Studies of adult rape victims demonstrate that they were often raped or
incessantly abused as children and that they are quite prone to being
raped again in their adult lives (Russel, D.,1986). Those who abuse
children sexually have very often been sexually abused themselves. And,
some of those who make repeated suicidal attempts give vivid past
histories of long standing childhood horrors. (Herman J. and Van Der
leolle B., 1987).
This article on the psychological
consequences of child hood sexual abuse in Sri Lanka and its issues in
the Sri Lankan context uses cases vignettes from the authors clinical
experience in order to elucidate the salient signs and symptoms that
characterise individuals who are sexually abused in childhood. These
cases were chosen due to the prominence of the signs and symptoms under
consideration. It is believed that such vignettes would assist in
providing a real life picture of the short term and long-term
consequences of sexual abuse on the psychological health of the child.
However, this approach could be improved further if more cases were
analysed and presented to indicate the frequency of occurrence of a
particular signs and symptoms.
This was not attempted as the number of cases that author had documented up to now was considered not enough.
Four characteristics common to most cases of childhood sexual abuse
There are several
well-known psychological consequences that characterise childhood sexual
abuse - school problems, anxiety, depression, attempts at suicide and
aggressiveness are commonly seen.
According to Terr
(1991), there are four characteristics that are particularly common in
traumatised children. They are (a) strongly visualised or otherwise
repeatedly perceived memories of the traumatic event (b) repetitive
behaviour (c) trauma specific fears and (d) changed attitudes about
people, aspects of life and the future.
a. Visualised or otherwise repeatedly perceived memories
The ability to re-see or
even re-feel the traumatic incident is a commonly reported phenomenon in
victims of trauma - in both children who have been sexually abused and
adult survivors of childhood sexual abuse. These visualisations are
strongly stimulated by reminders of the traumatic event, such as when
they revisit the place they had been abused. However, they may come up
entirely unbidden too.
These children may “see” and
“feel” the traumatic event at any given time of the day: during school,
at leisure when watching television or at mealtimes. They feel
powerless to prevent these memories coming up in their mind, and it
would be a cause great distress to them. Even those who were toddlers at
the time of the abuse may “re-see” and “re-feel” the experience over
and over again. This may be indicated by the child drawing what they
"see" or acting it out like a movie.
Case 1
A 12-year old boy was
sexually abused when he went to the school toilet. The abuser had put a
knife at his throat and asked him to stroke his genitals. Afterwards
the man had fondled and kissed the boy’s genitals. When recounting the
incident, the victim said that his legs were trembling with fear and
that his mouth felt locked during the event. He had felt he was a bad
boy and bad things were done to him.
Later, at home, when studying or when playing, the memory of the event
used to come to his mind and cause him great fear that the abuser would
come to "get" him. At these times he used to cry for his mother or
father, asking them to be near him to protect him from the abuser.
b. Repetitive behaviours
Repetitive enactment’s of
the traumatic experience is commonly seen in children who have been
sexually abused. Generally these children are unaware that their
behaviours and physical responses repeat something of the original
traumatic incident(s). Sometimes, behavioural re-enactments may recur
so frequently as to become distinct personality characteristics in
adulthood.
Case 2
A six-year old girl’s
mother noticed that her daughter plays "sexually" with her dolls. She
used to make the male doll kiss the girl doll on the lips and then she
would giggle. She goes on engaging in this kind of "sexualised play"
until interrupted by an adult. The mother also reported to the author
that when the child sees couples kissing (such as in movies), she points
at them and giggles. It was later found out that the little girl’s
father had been sexually abusing her and has done to her the things she
had been doing to her dolls.
Sometimes, a child shows
such sexually repetitive behaviour, non-abusive adults may ask him what
these behaviours mean. If the child has been sworn to secrecy by the
abuser he might not tell the inquiring adult. This is not because the
child enjoys the sexual abuse and is thus colluding with the abuser and
refusing to tell (as some people tend to believe), but because the
perpetrator had frightened or sworn the child to secrecy about the
sexual abuse. The abuser may have told the child that all sorts of
horrible things may happen to him or his loved ones if he tells anyone
about the abuse. Thus, it is important that adults who suspect that
sexual abuse has taken place/is taking place be aware that though a
child may not tell about the abuse or if the child is avoiding talking
about it, there could be a high probability that sexual abuse may have
actually occurred or is still occurring.
c. Trauma Specific Fears
Most traumatised children
trend to harbour specific trauma related fears well into later life,
unless he has received appropriate psychological therapy. These
children may fear men or women, sexual intercourse or marriage and this
fear may hamper their happiness in adult life. The traumatised child
may also fear more mundane things: such as the dark, certain types of
buildings and strangers. These fears are either directly or indirectly
related to certain facets in the traumatic experience the child had
undergone.
In case 1 mentioned before, the child was sexually abused during a
religious festival at his school. Since the incident, he refused to go
anywhere near the school. Once, when his father took that route to go
to the market he had started to scream and cry. He persistently refused
to go anywhere near the school and ultimately had to get admitted to
another school.
d. Changed attitudes about people, life and the future
Children who have not
experienced traumatic life events often enjoy a limitless sense of the
future. If asked what their life holds for them, they may come up with
numerous wishes and ideas: "I want to be a teacher", "I want to fight
for my country", "I want to be an actress", "I want to go to a better
school after my grade 5 scholarship exam" may be some of the answers.
On
the other hand, most children who have been sexually abused seem to
have a limited perspective on their life and their future. They may say
that they live their life one day at a time or that they cannot count
on anything or anybody to protect them. Girls who have been sexually
abused may feel that they cannot trust any man and consequently fail to
form satisfying and fulfilling intimate relationships in adulthood. For
the traumatised child, the future is a landscape filled with monsters
and devils. It is something they feel that they have no control of.
They feel that they are at the mercy of others.
Case 3
A
25-year-old woman came for psychotherapy to the author. She had
several physical complaints, but, without any basis of a physical
illness. She was also depressed and had some marital difficulties.
During therapy it was disclosed that when she was about 5 years old, her
father had tried to sexually abuse her one night. He had tried to
fondle her genitals but she had fought back and got away. Since then,
until she left home after her marriage, she lived in fear that the
father might try it again. She had warned her sisters to be wary of the
father. She had begun to believe that men have the authority to decide
what to do with a woman’s body. Therefore, she had given into the
sexual advances of many men, including domestic servants in her house.
She had not wanted to do so, but had felt helpless and felt that she had
no control over her sexual relationships.
Caring for the sexually abused child: difficulties in service delivery in Sri Lanka
A victim of childhood sexual abuse stated:
Inoka
(not her real name) was a 15-year-old girl who was repeatedly sexually
abused by her maternal aunt’s husband. Inoka’s father was dead and the
mother worked in the Middle East. After several months of the abuse,
the uncle took Inoka to Colombo, away from her village, and kept her in a
room with the promise that he would get her employment in the city. He
used to come to her room regularly for sex. The neighbours got
suspicious and the police was alerted. Inoka was taken to a residential
home - for her own safety from the uncle. Few months later she was to
referred to the author for a psychological assessment. I saw Inoka
sitting at the entrance to my office, a dishevelled girl, accompanied by
two authority figures. When I asked her to come in to my room and sit
next to me she said, "Madam, I was hoping that at least today I will
meet you. I have been brought here several times but we did not meet
you. Every time I made the journey to your office, I had to recount in
detail my life story to those who accompanied me. It pains me and
angers me to do so as it makes me recall all the sad things that has
happened to me". Later on she said, "the residential home is nice, but
we have nothing to do there, we can’t go to school. We just sit around
the entire day. I heard that when the case is closed, I will be
transferred from this home to another home, where the children are
locked up in rooms and can't even go out to the toilet without asking
for permission". Further she said, "at the court hearing the other
day, my maternal aunt was there. Nobody seemed to want to be kind to me.
They said that my uncle who did all these things to me had
disappeared. Can’t they find him? Where is the justice? If there is
no justice, I am going to run away from the home. Then the authorities
can put me in a prison. That is a far better reason to live a life of
hell than the reason I am now living - for no fault of mine".
Children
who have been sexually abused require treatment that is appropriate for
their age, scope, nature and extent of the abuse. In caring for the
sexually abused child, there need to be a multi-agency and a
multi-disciplinary approach. Government agencies such as the health
services, the legal sector, the police, the social services and
residential homes as well as non-governmental organisations (NGO’s) need
to provide a co-ordinated care in the overall rehabilitation process of
the child. Social workers, psychologists, psychiatrists, counsellors,
medical officers, lawyers, police officers, probation officers, judicial
medical officers, and paediatricians are some of the key persons who
may get involved at each stage of effectively managing a case of
childhood sexual abuse.
However, impeccable principles
are increasingly difficult to implement. Procedures concerning health,
law and social services seem to be uncoordinated and has created a
system that seem to loose the focus from our primary initiative in
caring for the traumatised child. Invariably, these agencies and
professionals who are involved in the care of the child tend to function
in isolation of each other and seem content in handling only their part
of the job, rather than trying to liase with every body else and
provide a co-ordinated service. Such a co-ordinated service would
involve an optimal and timely functioning of the justice system and the
social services system as well as the provision of timely medical and
psychological care in order to assist the child to face the future
bravely and positively. Unfortunately, due to the "loose" functioning of
the various systems and institutions within the country, the
accumulation of negative effects on the child increases. As indicated in
the case of Inoka, in this article, the lack of empathy, long time
delays, uncoordinated service delivery and lack of resources available
for rehabilitation, effects the child adversely.
When a
child is reported to be abused, he may be presented to a judicial
medical officer for a medico-legal examination and a
psychologist/psychiatrist for a mental health assessment. These reports
are deemed as expert evidence that may be used in a court of law when
deciding on the outcome of the case. In most instances these reports
tend to get delayed. This is primarily because there are very few
judicial medical officers, psychologists and psychiatrists in Sri Lanka
and the few who are working in the state sector find it difficult to
cope with the demands made on their time. Further, most of these
professionals are concentrated in the western province which makes it
difficult for their services to be made available to children in other
parts of the country. None of these judicial medical officers,
psychologists or psychiatrists work solely in the area of child abuse.
They also have other mandatory duties. It may be difficult for them to
juggle their many duties, leading to a delay in preparation of court
reports.
Unfortunately, some of these professionals are
not particularly keen on providing expert evidence reports on child
abuse. This may be because their professional training is not adequate
to interview children and detect abuse. Or, they may feel uncomfortable
appearing in court to give evidence – as in some cases, even though a
written report is presented to the court by the professional, he also
have to be present at the court hearings. This reluctance to apper in
courts is commonly seen because the court cases tend to get postponed
several times, taking months or even years for a verdict to be given.
Thus, having to attend court hearings over and over again, as the case
gets postponed every time, would rob too much time off the
professional’s busy work schedule.
There are several
reasons for the court case to be postponed many a times. Witnesses may
not have presented themselves at the court hearing, the judge may have
been scheduled to conduct a court hearing at another court at the same
time as the sexual abuse case or the documentation necessary for the
court hearing may be incomplete. Once the case is postponed, the time
gaps between the dates are lengthy. This is mainly because there seem to
be an unavailability of physical space (in terms of courtrooms) if the
case was to be taken up earlier.
During the time period
where the abuse is first reported to the police and the case is legally
closed, the child may live with his parents, the non abusive parent
(i.e. in the event that the father or the mother was the abuser) or in a
state or NGO run residential home. Unfortunately, the state of some of
these residential homes are far from satisfactory. Children who have
been placed in residential homes require a happy atmosphere that would
help soothe and heal the trauma that they had undergone. Many of these
homes do not provide an opportunity for the children to spend their life
as they would if they lived in a cheerful home atmosphere. They do not
have the opportunity for healthy intellectual and socio-emotional
development that is fostered when children have warm and caring care
givers, adequate resources such as food and clothing, opportunity for
play, opportunities to learn and education and good health care
facilities. Probably due to the lack of financial resources and
adequately trained staff, many of the residential homes does not seem to
cater for the diverse developmental needs of growing children -
especially children who have been sexually abused.
Thus,
for the sexually abused child, not only has he been abused and violated
in the most private and painful way possible, but the pain he receives
at the hands of "responsible" adults, who are those that have been given
the authority to look after him is tormenting indeed.
Improving the care of the sexually abused child: recommendations in improving the service delivery in Sri Lanka
It is the author's firm
belief that a crucial element in the process of service delivery for the
sexually abused child is a co-ordinating officer, who is authorised to
take responsibility for his allotted cases of sexually abused children.
Such a person would have the authority to co-ordinate all activities
related to the child, such as, obtaining the psychological and medical
assessments on time, advising and taking decisions regarding the
rehabilitation programme of the child, drawing up care plans that would
include opportunities for the continuation of the child's education and
academic growth (as in instances where the child is placed in a
residential home, away from his natural care givers) and present the
child for medical and psychological treatment (if such a need be).
Having such a central figure would ensure that a particular person is
responsible for the overall care of the child and that would prevent the
"loose" functioning that is now being seen. In the United Kingdom, the
social worker is the key person who does this all-important multifaceted
role. As we do not have a social worker system in Sri Lanka, it may be
possible to empower probation officers (of the Department of Probation
and Child Care Services, Ministry of Social Services) to take on this
role. As the number of probation officers per district may not be
sufficient to take on this new service, in addition to their present job
demands, it maybe necessary to increase the number of such officers as
well as give them training on this new facet of their job.
When
the alleged offender is a member of the family, whether it be a father,
brother or an uncle, invariably, it is the child who is removed from
the home until the court decision is being given. However, it is my
opinion that it is wiser to reverse this process, whereby the accused is
removed from the home and the child can continue to live with other
caregivers in his natural home environment. Many a times, if the father
is the offender, the mother tends to be reluctant to part from him and
may force the child not to confess of the incident or to withdraw the
statement that is made to the police. There could be many reasons for
this. The woman may depend on the man for her daily financial needs,
there may be a social stigma if her husband is imprisoned and, if the
community becomes aware of the incident, the woman may believe that it
would stigmatise the child and spoil the child's' prospects of marriage.
These are deep-seated social concerns of a conservative society such as
Sri Lanka. Much social change needs to occur in order to empower a
woman to take courage and stand by her child. One of the main factors
that lead to positive psychological health after an incident of a
childhood sexual abuse of a child is if the mother believes in the child
and is supportive of him. Therefore, empowering in the mother to stay
firm and to support the child, while acknowledging to herself that it is
a difficult task in a conservative society, is important.
The
quality of residential homes needs to be improved. The lack of funds
and resources may hamper this process. However, within these
constraints, it may be possible to make some small but significant
changes whereby the atmosphere of the home would resemble more of a
"home", rather than "residential home". If the children are given
opportunities to play, get involved in hobbies and mix with children in
the community where the residential home is situated, this could
"normalise' the institutional atmosphere of the residential home. This
is done very well in a residential home in Negombo - Don Bosco, which
cares for children who have been abused. In this residential home,
children have the opportunity of mixing with those of the community as
the authorities who run the residential home provides tuition classes
for children of the home as well as the children of the community. Thus,
as the community goes in and out of the residential home, the stigma
that the community may attach to the home tends to dissolve and the home
gets integrated in to the community, providing a more natural and
homely atmosphere for the children residing in it.
The
media pays an important role in giving the current message of sexual
abuse and its consequences to the public. Biased media coverage can
seriously hamper the process of preventing childhood sexual abuse. For
instance, a journalists' remark (as cited in De Silva, 2001) to an
observation made by De Silva (2001, implied that sexual abuse may be a
cultural norm in our country and that it has taken place in schools and
even among priests in Buddhist temples. These kinds of observations
would give the wrong message to the public and prevent the correct
awareness among the people. Further, many a times, the media is seen to
report the names, addresses and other pertinent information about the
abuse which would easily help the reader/viewer identify the victim of
the abuse. This is a misguided practice as though it is essential to
report cases of sexual abuse, its important to preserve the anonymity of
the parties involved.
Finally, the present law does not
indicate mandatory reporting of suspected cases of child sexual abuse. I
believe that it would be useful if it is made so, as it is mostly
doctors and clinical psychologists who may see such cases in their
routine clinical work. If the law indicate that such cases need to be
reported, more children who are being abused would come to the notice of
the relevant authorities.
Summary
The needs of the sexually
abused child are numerous. Not only should he be provided with timely
medical and psychological treatment needed to overcome the physical (if
any) and emotional wounds of the abuse, but also, he should be provided
with a range of services which provide optimal social service facilities
and timely interventions by the legal system, which would ensure that
justice has been done.
References
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Silva, D. G. H., Rubesinghe, N.K., Jayasekera, A., Wijayasooriya, W.,
Hewamanna, T., & Ginige, V. (1997). Incidence of childhood sexual
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