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Truly 'A Can of Worms'! The booklet A Can of Worms, written by Sarah Nelson and Sue Hampson, and issued by and with the authority of the Scottish Executive, builds up a picture in the reader’s mind, without explicitly saying so, of widespread, undiagnosed child sexual abuse (CSA) which can only be identified if all those dealing with disturbed adults react, ‘particularly if someone displays several of the effects listed below’. The authors have failed to make it emphatically clear that any of these effects may have other causes. The brief note of caution: ‘Of course, there are often other or additional reasons for these problems’ is dangerously inadequate, given the book’s powerful and seductive message, and the qualification contained in the next sentence, ‘however, the possibility that CSA is part of the underlying reason should always be considered’. And, ‘being sexually abused does NOT mean people will necessarily suffer the problems below.’ These ‘effects’ are 13 major ‘pointers’ and the same number of ‘more subtle effects’ (including ‘the way they hold their bodies’, ‘difficulty sleeping’, ‘cleaning and tidying their houses repeatedly’ and male ‘sexual orientation’), each of which should, surely, carry details of possible alternative causes to help the reader avoid making false diagnoses. In offering the book as an important component in the necessary and laudable fight against the very real tragedy of CSA, the authors have, consciously or unconsciously, used this to give legitimacy to the questionable advice it gives and to the recruitment to the ‘cause’ of a wide range of people, ‘including staff and volunteers working in mental health, community projects, counselling and support services, health and social work services, homeless projects, addiction services, criminal justice, older people’s projects and in young people’s services’. They do not, the book claims, require ‘higher qualifications and lengthy training’. The statement, ‘we’re not looking for great experts, we want human beings’ is potentially misleading to those without knowledge of the broader psychological and physical health issues of which CSA is part. A quote in the Scottish Executive’s news release, attributed to the authors, said, ‘We want to break through the myth that this is only for highly trained specialists. In fact human qualities and skills like acceptance, empathy and respect are what matter most.’ Although qualified by reference to the ‘additional considerations………..most notably child protection guidelines’, the claim that the ‘general principles outlined here are also relevant for those working with children and young people’ can only give cause for further concern. If the consequence of the booklet is to mislead thousands of paid and voluntary workers in a wide range of fields into believing they can recognise a history of CSA in clients with ‘psychotic episodes, dissociation, personality disorders, suicidal thoughts and behaviour, self-harm and self-mutilation, post traumatic stress disorder (including night terrors, flashbacks, phobias, anxiety states, panic attacks, amnesia), eating disorders, dysfunctional sexual relationships, physical ill-health, anger and aggression, alcohol or drug misuse, and depression/post natal depression’, then it can only be a matter of time before we have a new wave of false allegations. Indeed the reader is implicitly exhorted not to be reluctant to raise or discuss sexual abuse with ‘service users’ for fear of triggering child protection guidelines and starting a chain of events which could involve police, judiciary and/or court appearance, or because, ‘sexual abuse is so common that if we started a service we’d be overwhelmed’. The use of the phrase, ‘so common’, in this way is, perhaps, a clever way of implying that CSA is endemic. The authors skate around the issues of recovered memory and Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder (MPD). In a brief reference that is potentially dangerous for practitioners and their clients, they state, ‘it could be worth sympathetically exploring the possibility of dissociation and working out ways of “grounding” which work for the survivor, perhaps with help from a mental health professional (italics added). Both recovered memory therapy and DID are minefields, even for the most highly qualified and experienced of mental health practitioners and the authors should have taken note of well-researched evidence of the damage they can do in the wrong hands. The risk of inducing symptoms in a patient as a result of the counsellor’s wrong words or actions is considerable. In the words of Dr Ray Aldridge-Morris, Consultant Clinical Psychologist of over 35 years standing, ‘MPD is itself a fiction. I debunked this psychiatric hoax in a book in 1989. There is no such clinical entity as MPD and no psychopathologist with any credibility would ever make such a diagnosis. It was always largely a North American phenomenon and those clinicians foolish enough to so label their patients are now facing the consequences. These include lawsuits from the patients themselves and their families.’ Dr Aldridge-Morris was responding to a review in the New Statesman of Matt Ruff’s novel, ‘Set This House In Order’ in which MPD is discussed at length. The issue of recovered memory is not explicitly discussed but the authors have sought to introduce the possibility into the reader’s mind e.g., ‘…one survivor in Beyond Trauma1 kept inflicting very severe burns on her arm before recalling that, as a child, her abuser had repeatedly burned her arm on the cooker’. By not qualifying the comment, ‘Amnesia contributes to the uncertainty and self-doubt which so many survivors feel, especially given the waves of media publicity about alleged “false memory syndrome”…….Am I a fraud? Did I make it up or imagine this? Was my brother there or not? Did my mother try to stop it?’ the authors have failed in their duty to warn practitioners of the unreliability of recovered memory and of practising recovered memory therapy. Then, in two further veiled references to recovered memories, the book says: ‘I once saw a woman go back to when she was a child in her bedroom, the terror, breathing etc. I wasn’t sure what to do, so I just talked her down’; and, ‘confusing “memory blanks” about her childhood’. Again, there is massive, documented evidence of the damage that even the experienced practitioner can inflict, both to the client and his/her family, by encouraging or wrongly reacting to so-called ‘recovered’ memories. The definitive document, ‘Recovered Memories of Childhood Sexual Abuse – Implications for Clinical Practice’ by the late Professor Brandon and his team of psychiatrists, published in the British Journal of Psychiatry, effectively discredited the practice. Yet there is no reference to it in A Can of Worms (see below). Not surprisingly, the booklet’s recommended reading list includes Courage to Heal and other books by Ellen Bass and Laura Davis. Courage to Heal was described in the House of Commons by Claire Curtis-Thomas MP, Chair of the All-Party Parliamentary Group on abuse investigations as, ‘one of the most dangerous self-help books ever written. Its authors encourage readers to search their memories for dark and shameful episodes of sexual abuse which, they are told, may have been completely hidden by repression. The book says, “If you think you were abused and your life shows the symptoms, then you were”. Symptoms seem to include virtually anything except in-growing toenails. The book advocates that ‘survivors’ fantasize about castrating or murdering their abuser and says, “Wanting revenge is a natural impulse, a sane response. Let yourself imagine it to your heart’s content.” ’ The advice given by Nelson and Hampson, ‘believe the victim’ is a clear reflection of the first part of the above quote from Courage to Heal. Although there are 36 publications (among a total of 68) listed giving advice to Counsellors and Therapists, the Brandon report - a vital source of reference for anyone dealing with CSA, is totally ignored. No-one can argue with the forward by Lewis Macdonald, Deputy Minister for Health and Community Care in Scotland, which calls for ‘better and more joined-up services to help improve support for survivors of childhood sexual abuse’ and for ‘better training and good practice guidelines’ (indeed, this has been said many times, most recently in the 59 recommendations made by Professor Pat Cantrill, following the case of five Sheffield children who were found living in squalor and near to death from starvation, despite the family’s problems being known to a number of agencies). But the later statement that the booklet ‘aims to support people working in a wide range of services in gaining a better understanding of the needs of people……, how best to raise the issue and how to respond in an appropriate, sensitive and supportive way’ is not justified by its content. Regrettably, the comments of the minister give unwarranted official authority to the booklet as part of the Scottish Executive’s £2 million scheme ‘to fund local demonstration projects to share good practice nationally.’ Unfortunately, the booklet is likely to give credence to unproven practices and entrenched beliefs within the CSA and the child protection culture, particularly the presumption of abuse histories in disturbed children and adults and the use by well-intentioned amateurs of recovered memory therapy and suggestive interviewing techniques to elicit ‘disclosures’. There can be little doubt the booklet truly lives up to the title, A Can of Worms. References: Nelson, S. 2001. Beyond Trauma: Mental Health Care Need of Women
who Survived Childhood Sexual Abuse. Edinburgh Association for
Mental Health
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