Age, Ageing And menTAl heAlTh over The liFe course 75
high parental warmth is associated with decreased risk of insecure attachment styles (Stansfeld et al. 2008). Similarly Kiernan and Huerta (2008) found that economic deprivation and maternal depression separately and together diminish the cognitive and emotional well-being of children.
Part of this impact arises from the less nurturing and engaged parenting style of those with fewer economic and emotional resources.
This interaction of (lower) class position and emotional resources highlights that models of mental health causation based either on material or psychological explanations are less persua- sive than ‘both/and’ models. Poverty increases the risk of mental health problems but not all poor people develop the latter; mediating psychological factors are therefore important to consider.
This links with the next section, which starts with the point that the psychological construction from victims about their adverse conditions in childhood is variable. Moreover, the presence of the adversity of abuse can happen in all classes, which highlights the need to consider family peculiari- ties not just social group membership.
76 A sociology oF menTAl heAlTh And illness
‘Sexually inappropriate behaviour’ refers to the tendency of victims to become sexually interested in peers and adults in a way that is unusual for their age group. ‘Sexual aggression’ refers to this process when it is associated with anger or violence. This trio of symptoms characterizing child victims of sexual abuse does not mean that they have only these problems. Other forms of distress reported include those suffered by non-abused psychiatric referrals (anxiety, depression, night terrors, language delay, hyperactivity, stealing, peer relationship difficulties, eating disorders and so on). However, the trio does seem to mark sexual abuse victims off from non-abused children with emotional problems.
A number of epidemiological studies now indicate that these immediate externalizing effects in childhood translate into adult problems both of ‘acting out’ and of experienced distress. Stud- ies of long-term effects have been on both clinical and community populations. Here we will give an example from each. Briere and Runtz (1987) examined the records of 152 consecutive women requesting appointments at the counselling department of an urban Canadian community health centre. Table 5.2 summarizes their results.
The significant results in the far right column alert us to the symptom profile of the abused group. Notice the suicidal behaviour and the substance abuse, as well as the battered adult picture.
This phenomenon of ‘revictimization’ is common in adult survivors of childhood abuse. There is some evidence that disproportionate numbers of victims are found working as prostitutes (Browne and Finklehor 1986).
Table 5.2 differences between sexually abused (AB) and non-abused (nAB) female attenders at a canadian community health centre for crisis counselling (n = 152)
% NAB % AB Sig. level
current psychotropic medication 14.0 31.3 0.01
history of hospitalization 22.1 19.4 ns
history of attempted suicide 33.7 50.7 0.03
Battered as adult 17.6 48.9 0.0003
history of rape 8.3 17.7 ns
history of drug addiction 2.3 20.9 0.0005
history of alcoholism 10.5 26.9 0.02
restless sleep 54.7 71.6 0.03
nightmares 23.3 53.7 0.0001
Anxiety attacks 27.9 53.7 0.001
Trouble controlling temper 18.6 38.8 0.006
desire to hurt self 18.6 31.3 0.07
sexual problems 15.1 44.8 0.0001
Fear of men 15.1 47.8 0.0001
Fear of women 3.5 11.9 0.09
derealization 10.5 32.8 0.0001
out-of-body experiences 8.1 20.9 0.04
chronic muscle tension 44.2 65.7 0.008
Source: modified from Briere and runtz (1987).
Age, Ageing And menTAl heAlTh over The liFe course 77
Other studies indicate that some victims also become perpetrators. Estimates of this vary.
Longo (1982) reported that 47 per cent of male adolescent sexual offenders had been victims them- selves. Becker (1988) reports a figure of 19 per cent in her adolescent sexual offenders’ clinic.
The focus of the clinical discourse on sexual abuse is on male perpetrators and, with the exceptions just quoted, female victims. Recently, a minority interest in female perpetrators has emerged suggesting that they constitute between 1 per cent and 10 per cent of offenders. Women are much less likely to act alone than male abusers (though paedophile rings of men working together also exist). The infamous cases of Myra Hindley and Rose West illustrate this type of male–female collusion in a dramatic way because they culminated in several murders. Less dra- matic cases, stopping short of death, receive less publicity, though in 2009 in England, the case of a female nursery nurse as part of a paedophile pornography ring was discovered and prosecuted, with extensive coverage in the mass media.
Given that the data reflect a preponderance of female victims and only a small minority of female perpetrators, it alerts us to the problems of accounting for sexual abuse, simply in terms of adults repeating abusive relationships from childhood. The switching from victim to perpetrator is not inevitable, nor can it be invoked as a strong causal explanation of most abusive acts, as most victims of both sexes do not go on to become perpetrators.
Turning to an example of a community survey, Stein et al. (1988) interviewed 3132 adults in two Los Angeles areas – one predominantly white, the other Hispanic (Table 5.3). The symptom profile of victims is confirmed again in this study. Drug and alcohol abuse is evident, as are anxi- ety and depression. Significant differences do not appear in the groups in relation to diagnoses of schizophrenia, mania and obsessive-compulsive problems. The final row shows the consistent pattern of victims being more likely overall to receive a psychiatric diagnosis than non-victims.
Elements in this range of adult personal difficulties seem to be more amplified in victims of intra- familial abuse than for those abused by non-relatives. Not only do they suffer the psychological impact of assault common to all victims, they also struggle with a particular sense of betrayal and stigma.
Finally in this section it is worth noting the likely underestimate of childhood sexual abuse as a social problem. The actual rate of childhood sexual abuse is difficult to ascertain because of a reluctance to disclose a traumatic and stigmatized event. A study conducted in 2004 indicates the pervasiveness of a reluctance to disclose with 78 per cent of women interviewed about their experiences indicating that they had not told anyone about the sexual abuse when it happened.
The most common reason for this was fear of not being believed (Lundqvist et al. 2004).
Table 5.3 lifetime prevalence of psychiatric problems in those sexually abused (AB) and those not (nA) in childhood (n = 3132)
Men Women
% NA % AB % NA % AB
Alcohol abuse 23.2 35.7 4.1 20.8*
drug abuse 7.8 44.9* 3.1 13.7*
severe depression 3.9 13.8 5.5 21.9*
Phobic anxiety 7.0 6.5 12.5 34.2*
Any psychiatric diagnosis 34.0 71.2* 24.0 58.6*
*significance level of 0.05.
Source: Figures summarized from stein et al. (1988).
78 A sociology oF menTAl heAlTh And illness
The stigma of the abused victim and the shame and criminality of the perpetrator make accurate empirical estimates of child sexual abuse particularly difficult, but logically suggest underestimation. Baker and Duncan (1985) suggest child sexual abuse rates of 0.25 per cent for relative and 10 per cent (12 per cent female and 8 per cent male) for non-relative abuse in Britain. If these are accurate estimates, around 4.5 million British adults are victims of earlier sexual abuse. In the USA, Russell (1983) reported much higher rates in her community survey of women – 38 per cent reporting one experience of sexual abuse before 18 with 4.5 per cent of the sample reporting abuse by their biological fathers or stepfathers.
Prevalence rates of abuse victims of around 30 per cent are quoted by studies of psychiatric outpatient records (Gelinas 1983). This range of estimates poses a problem of interpretation. If Russell’s estimates are correct, then it would appear that while the rates in the community of reported sexual abuse are high, this is not translating into a proportionate number of victims becoming psychiatric patients. What is implied instead, as with the Brown and Harris (1978) study of female depression in the community, is that there is a ‘clinical iceberg’ (see Chapter 1), with only some of the abuse victims presenting for professional help. By contrast, if the Baker and Duncan data are more accurate, then it would appear that sexual abuse during childhood is being reflected more closely in prevalence rates of psychiatric disorder.