Sexual Abuse & Sexual Dysfunction or Addiction - Case Study Example

Running Head: Sexual Abuse & Sexual Dysfunction/Addiction Sexual Abuse & Sexual Dysfunction/Addiction of the of the Sexual Abuse & Sexual Dysfunction/Addiction Introduction The term ‘abuse’ has a Latin root abusare but it is not until early modern times that it has found its way into European languages in its present sense as misuse, disuse, ill-treat, violate, defile or pervert. Sexual abuse and harassment are relatively recent legal and moral concerns. They both involve sexual advances or actions that occur against the wishes of the person toward whom they are directed or in situations in which that person is either incompetent to consent or where consent was given under conditions that are reasonably seen as coercive. The recent attention these topics have received has come primarily from concern with institutionalized power inequalities as these affect various social groups (Finkelhor, 1984 pp. 78-88). This paper discusses sexual abuse & sexual dysfunction/addiction and its theories and concepts in a concise and comprehensive way. Sexual Abuse: Its Types and Theories Finkelhor (1984 pp. 78-88) The statistics on child abuse in the UK are truly horrifying, at least one child dies every week as a result of an adults cruelty, and thousands more endure abuse and neglect at the hands of their carers. Yet the known facts reveal only a fraction of the problem. This is because most cases of abuse go unreported, leaving children to suffer the pain and misery of abuse in silence. Over a quater of all recorded rape victims are children, three quarters of sexually abused children do not tell anyone at the time and around a third are not able to tell anyone about the experience later. More than 30,000 children are on child protection registers because they are at risk of abuse. Recent NSPCC research involving two thousand eight hundred and sixty nine adults revealed that one in ten of them had suffered serious abuse or neglect during childhood. Each week more than four hundred and fifty thousand children are bullied at school. Terrifyingly these statistics are only for the UK, meaning that even more children out there are victims of abuse and cruelty Frighteningly abuse is often known about or suspected by another adult who could have done something about it and a quater of all recorded rape victims are children. Everyone has the responsibility to stand up for children. Many children are very vulnerable and too scared to tell anyone about what they are going through in fear that their abuser will find out. Thus showing how important it is for everyone to ensure that children are being cared for the way they should be, whether they know the child or not. More disturbingly most abuse is committed by someone who the child knows and trusts. Again indicating just how important it is for everyone not just the professionals to help to protect children. Mary Marsh the NSPCC director and chief executive states: "No law can ever be enough. Protecting children from abuse or neglect can and should not be left solely to professionals and politicians. Everyone - individuals, families and communities - shares a responsibility to look out for children." This is what we should all be doing. As much as we may like to think that we are doing our bit there are still thousands of people out there who stand back and do nothing, many people often know about abuse yet dont do anything about it and another childs life is lost. There are four internationally recognised types of maltreatment, Neglect, Physical abuse, Emotional abuse and Sexual abuse. Neglect, is seen as a failure to provide for a childs basic needs, whether it is physical, medical, or educational. Emotional abuse is seen as an inattention to a childs emotional needs, and a failure to provide psychological care. Physical abuse is an injury, ranging from minor bruises to severe fractures or death as a result of punching beating and kicking etc. Sexual abuse includes activities by a parent or caretaker such as rape incest or exploitation through porn/ prostitution etc. It is emotional abuse and neglect which possibly are the most difficult to pinpoint, as some situations do not always mean a child is neglected. Sometimes cultural values, standards of care in the community and poverty may be contributing factors, indicating that the family is in need of assistance (Finkelhor, 1984 pp. 78-88). Issues of debate are the causes of child abuse and its cures. Cases discovered by Kempe and his colleagues were quite severe and led to hypotheses that parents who engaged in such harmful behaviour were quite disturbed. These professionals also observed that abusive parents were often themselves abused as children. This gave rise to theories about the intergenerational transmission of child abuse. On the other hand, researchers who examined the characteristics of cases reported to child welfare agencies described environmental stresses, such as poverty, unemployment and social isolation, as key factors leading to child maltreatment. At present most professionals accept that multiple factors play a part in child maltreatment, and models which include parental, victim, family, environmental and cultural factors are espoused (Masson, 1985, pp. 56-69). Although society is likely to intervene regardless of who engages in abusive acts against children, behaviours of special concern are those committed by childrens caretakers. In Lockean terms an abuse by a childs carer would be of particular concern for it would be a breach of a special trust. But abuse in any case has to be contextually understood; it is not, as some professionals may think, an absolute. Professionals may fail to appreciate that contributing and causal factors and their relative importance vary based upon type of maltreatment and the individual case. Physical neglect is, as a rule, closely tied to and often synonymous with poverty (Masson, 1985, pp. 56-69). In contrast, sexual abuse is likely to have its aetiology in the offenders psychopathology, particularly sexual arousal to children. Physical abuse is often precipitated by environmental stress, but parents may also have significant disturbance, particularly in impulse control. There is also variability in dynamics within the general categories of maltreatment. For example, the amount of disturbance in a parent who inflicts multiple fractures is much greater than that in a parent who bruises a childs arm. Similarly, two mothers may fail to nurture their children, but one may do so because she is overwhelmed by homelessness, poverty and unemployment, and the other because she is an alcoholic. As a society we have so far invested more effort in identifying child maltreatment than in its prevention and cure. In the USA, and to a somewhat lesser extent in England, prevention programmes, supported by voluntary agencies, have been administered to children in schools and other settings. However, the majority of programmes target sexual abuse and rely upon the victim to resist and report their abuse. Few resources have been employed to teach teenagers appropriate child care and parenting or to provide training for expectant parents (Tong, 1984, pp. 214-217). In both the USA and England, there have been drastic cuts in social welfare programmes, which are probably the most effective means of preventing child maltreatment. As noted above, where welfare programmes are absent or inadequate children come to serve functions that deny their childhood and deny their growth towards autonomy. Welfare programmes not only alleviate the environmental stresses that can precipitate abusive or neglectful behaviour, they are actually necessary conditions to the constitution of the ‘child’. Although there has been a dramatic increase in reports of child maltreatment in the last forty years (Tong, 1984, pp. 214-217), in fact care of children has generally improved. The expanding number of reports is the result of societal and professional attention to the plight of children, a broadened definition of child maltreatment and new child abuse legislation and policy. However, it is not sufficient to identify and label child maltreatment. Sufficient resources, for broader social welfare programmes and specific services for child abuse, must be invested to remedy particular problems. More generally a society that does not invest in adequate and appropriate welfare programmes undercuts the very conditions that allow for the constitution of the child and the development of childhood. A society that condemns child abuse while cutting back on welfare programmes is generating a social and political fault line of major proportions. It is engaged in a deep and irreconcilable contradiction that can only end at best in tears and at worst in something far more terrible. Women in the Workplace Men as well as women can experience sexual harassment, and women as well as men can be guilty of it. Male-instigated, heterosexual harassment, however, is not only the most common, but, given the nature of gender inequality, the only sort whose implications systematically go beyond the individuals immediately affected (Tong, 1984, pp. 214-217). As Catherine MacKinnon argues in her ground-breaking study, such harassment in the workplace is a form of sex—i.e., gender—discrimination. Rather than being an aberration, it is the consequence of the power inequality between men and women, along with the sexiness that is ascribed both to inequality itself and, relatedly, to the tacit job descriptions of many traditionally womens jobs. Sexual harassment has consequences for the workplace equality even of women who are not the immediate victims of it, making it difficult for women to see themselves and to be seen by others as competent and as appropriately in control. Through the intertwined social constructions of gender and of sexuality, women are defined not as independent, assertive, and competent, but as normatively subordinate and vulnerable, and they are characterized by their real or perceived accessibility to sexual advances. Since sexual harassment both depends on and reinforces these attitudes, it affects men and women very differently, whether they experience it directly or not (Russell, 1984, pp. 78-89). Students Beginning in the 1970s, sexual harassment of students by teachers has increasingly come to be seen as a major problem in colleges and universities, and many schools have drafted policies to deal with it. The problem can be identified in a number of quite different ways (Russell, 1984, pp. 78-89). It can be seen to lie in the pressing of unwanted sexual advances by anyone on anyone else, made worse by the use of threats or inappropriate promises. Thus, anyone can sexually harass anyone else, though only some have ready access to such things as grades to be used as bribes and retaliations. On such a view the power difference between teachers and students is only contingently relevant: should a student have some means of bribing or threatening a teacher or another student for failing to respond to sexual advances, the situation is, on this view of the matter, precisely analogous to the more usual one. Clients and Patients The sort of incompatibility many believe to obtain between the roles of teacher and lover is more widely believed to obtain between the roles of clinician or therapist or counsellor, and lover, so much so that in some cases such sexual relationships are held to constitute rape. They are consistently proscribed in codes of professional ethics. The inequalities of power and the dependence that characterize the client/clinician relationship are such that the argument that a sexual involvement can be in—or at least not against—the clients interests is usually taken not only to be unsound but also not to be in good faith, and such involvement is typically regarded as an abuse of power and responsibility. Not only are the conditions for autonomous consent arguably absent in such cases (Lawrence, and Charlotte, 2001, pp. 69-88), but the clinician has entered into a relationship in which the clients real interests and needs, rather than the satisfaction of sexual desire on the part of either or both of the parties, appropriately govern her or his actions. Post Traumatic Stress Disorder (PTSD) Many of the inmates that we have seen often have one diagnosis that is intertwined with their major problems: Post Traumatic Stress Disorder (PTSD). How do we effectively help these people recognize and deal with the traumatic events in their lives so that they can deal with PTSD and possibly prevent this disorder from manifesting into further psychiatric problems? Someone with PTSD may experience unwanted memories when exposed to certain stimuli; sometimes these stimuli are real or perceived. Many times these people turn to substance abuse to deaden troubling symptoms or develop a concurrent psychiatric problems, such as eating disorders, OCD, or multiple personality disorder. A PTSD episode activates the fight or flight response from the sympathetic nervous system. When triggered inappropriately in PTSD, the fight or flight response can have negative social consequences such as chronic anger, violence, aggression, disassociation and an altered self-perception. These feelings many times lead to illegal behavior and incarceration (Mrazek and Kemp, 1981, pp. 134-141). Diagnosis can be difficult because signs and symptoms vary among different people. Careful clinical interviews are used to evaluate the clients psychological status. Most treatment includes a combination of patient education, drug therapy, and psychotherapy (Mrazek and Kemp, 1981, pp. 134-141). Studies have shown that letting someone just talk about a catastrophic event in their lives reduces the likelihood of developing PTSD. In addition to professional help, there are a number of techniques that help prevent problems from escalating, the clinician should: Provide a calm, safe environment. Meet the clients basic needs by addressing fatigue, hunger, loneliness. Establish trust by assuming a positive, consistent, honest, and nonjudgmental attitude. Communicate clearly and honestly. Help your client to realize that his/her symptoms are common reactions to stressors. Help your client feel that they are not responsible for their disorder. Disassociative Behaviours Formerly known as Multiple Personality Disorder, Dissociative Identity Disorder is described by the DSM-IV as “a failure to integrate various aspects of identity, memory and consciousness” in which such functions are disintegrated to the extent that two or more personality states or identities develop, thus the term “multiple personalities”. Dissociative Identity Disorder is a complicated psychological problem with unique symptoms across cases, not allowing for uniform diagnoses. Psychologists debate over its very existence as a legitimate condition as well as whether its etiology is based on a posttraumatic model or a sociocognitive model, both of which hold value as a reliable approach (Elzinga; Phaf; Ardon; van Dyck, 2003). The disagreements regarding the existence of Dissociative Identity Disorder as a genuine condition are rooted in the inadequate amount of experimental investigations as well as the recent increase in amount and, along with it, the variety of cases that have developed. In an effort to come to a level of diagnostic validity, researchers have examined any sets of clinical features and psychological processes that separate and differentiate patients of Dissociative Identity Disorder with those that do not have the condition. Using a research process known as a self-report measure as well as other techniques, evidence has been found that DID patients actually do display a set of common clinical features. Included in these are “episodes of partial or total amnesia, history of childhood trauma, non-psychotic hearing of voices, subjective sense of being controlled by a foreign entity, and alterations in identity such as diary entries in different handwritings.” While these results stayed true to the hypotheses of the researchers, the reliability of the testing has seen scrutiny by critics due to the small numbers of participants. Despite this criticism, as well the probable influence of experimenter bias, the findings still support the assumption of DID patients exhibiting clinical features that differentiate them from those without the condition. These features were present at a significantly greater level in those with Dissociative Identity Disorder than in the control group of non-DID and mixed-diagnosis psychiatric patients. Sexual Dysfunction Sexual dysfunction is defined as and impairment of the normal physiological processes of arousal and orgasm. There are many forms of sexual dysfunction, or difficulty in sexual functioning and their causes are complex. In some cases men may develop performance anxiety which is a fear that one will be unable to meet the expectations of oneself or ones partner for sexual performance. This is only one example of a sexual dysfunction, there are six main types (Mrazek and Kemp, 1981, pp. 134-141). There are physiological and psychological causes that may be contributing factors to any sexual dysfunction. There are two types of dysfunctions that are strictly male problems. The first of those is erectile dysfunction (impotence). Generally this is the inability to have or maintain and erection firm enough for intercourse. This dysfunction can be divided into two groups: primary erectile dysfunction and secondary erectile dysfunction. Primary erectile dysfunction is when the man has never been able to have sexual intercourse and secondary erectile dysfunction is when erection problems occurring on at least twenty-five percent of sexual encounters. Physical causes for them are possibly diabetes, circulatory conditions, heart disease, drugs, extreme fatigue, alcohol consumption, or hormone deficiencies. Psychological causes for these dysfunctions could be performance anxiety, guilt, difficulty in expressing desires to partner (Giovannoni and Becerra, 1979, pp. 178-186), or severe anti-sexual upbringing. The second group of male dysfunctions is premature ejaculation. This occurs when there is a rapid ejaculation that is beyond the mans control and his partner is non-orgasmic in at least fifty percent of their intercourse episodes. The possible causes of this dysfunction are almost always psychological. The man has learned to ejaculate quickly due to guilt, fear of discovery while masturbating, hurried experiences in cars or motels, and so on (Giovannoni and Becerra, 1979, pp. 178-186). There are three types of sexual dysfunctions that are both male and female. The first of these is dyspareunia. This is painful intercourse, more frequent in women but also occurs in men. The causes of this dysfunction are mainly physical, such as irritations, infections, or disorders of the internal or external genitals. The second of the male-female dysfunctions is inhibited sexual desire, or sexual apathy. This occurs when there is a lack of willingness to participate in sexual relations due to disinterest. The physical causes of this dysfunction may be hormone deficiencies, alcoholism, drugs, or chronic illness. The psychological factors may be depression, prior sex trauma, relationship problems, or anxiety. The final male-female dysfunction is sexual aversion. This happens when there is a lack of participation in sex due to overwhelming fear or anxiety. The causes are always psychological. They are severe parental sex attitudes, prior sex trauma, partner pressure, or possibly gender identity confusion. Similar to male problems, females also have two main types of sexual dysfunctions, the first being orgasmic dysfunction. This occurs when the woman has an inability or difficulty in reaching orgasm. This difficulty can be further separated onto three groups: primary orgasmic dysfunction, secondary orgasmic dysfunction, or situational orgasmic dysfunction. Primary orgasmic dysfunction occurs when the woman has never had an orgasm. Secondary orgasmic dysfunction is a result of the woman being regularly orgasmic at one time, but no longer is, and situational orgasmic dysfunction is a result of orgasms occurring only under certain circumstances. The physical causes of these dysfunctions may be chronic illness, diabetes, extreme fatigue, drugs alcohol consumption, hormone deficiencies (Polansky, Chalmers and Williams, 1981, pp. 89-99), pelvic disorders, and lack of appropriate or adequate stimulation. Psychological causes may be fear of evaluation, poor body image, relationship problems, guilt, anxiety, severe anti-sexual upbringing, difficulty in expressing desires to partner, prior sexual trauma, or childhood sexual abuse. The final type of dysfunction is vaginismus. This is when the muscles around the outer one-third of the vagina have involuntarily spasms, and penile insertion is impossible or difficult and painful. The causes of this dysfunction are mainly psychological. The woman has learned to associate pain or fear with intercourse, owing to prior sexual trauma, severe anti-sexual upbringing, or guilt (Polansky, Chalmers and Williams, 1981, pp. 89-99). All of the dysfunction discussed are not life-threatening but may present a problem to those who have them. All have physical and/or psychological causes that may be behind these troubling dysfunctions. With proper care and advice one will be able to overcome any of these problems if he or she so wishes (MacKinnon, 1979, pp. 123-131). Different Clinical Approaches There are six phases in a sexual activity: desire, arousal, excitement, orgasm, satisfaction and aftermath. Sexual desire is the first step of this chain and therefore if an individual encounters problems, the remaining phases are effected or totally blocked. Most understanding of sexual desire is based on clinical experience rather than any empirical evidence arising from studies or investigations into the matter, this is mainly due to the fact that it is, as mentioned before that sexual desire is hard to define, quantify and compare (Gil, 1970, pp. 199-205). Experts acknowledge that desire problems are the most difficult of all sexual dysfunctions to treat. The reasons being that most cases of low sexual desire are not only quite complex, but are diverse in apparent etiology and maintaining factors. Low desire must be examined on its own terms and treatment must be tailored to the specific needs of the individual case (Gil, 1970, pp. 199-205). Before any sexual therapy commenced the patient would be checked of any medications and or substances being used that are suspected of decreasing libido. Many methods of sexual therapy have been devised over the years, each in specific defence of a particular supposed cause of the dysfunction. Suggested earlier, one psychological cause of lacking libido, bad experiences with sex has a specific defence called in vivo desensitisation. It is useful in combating fears and consists of low-level intimacy tasks. The initial goal is to eliminate the womans phobic avoidance of sexual situations, contacts and acts. In the case of anger or marital conflict, a patient will be proscribed marital counselling; if this is not successful obviously further exploration of other factors would follow (Neu, 1976, pp. 27-39). Marital or interpersonal therapy would also be useful in tackling desire problems involving distrust or fear towards ones partner. Conclusion I short, as elsewhere in discussions of sexual harassment and abuse, differences in perspective affect the definition of what is abusive, and, in ways that have been deeply controversial, analyses of these phenomena have given definitional and epistemic privilege to the less powerful. It is primarily for this reason that, as we currently understand these terms, their history is so recent: when epistemic privilege either resides with the more powerful or is detached from any particular perspective, these phenomena are literally invisible. References Finkelhor, David, 1984, Child Sexual Abuse: New Theory and Research. New York: Free Press, 1984. Sociology, pp. 78-88. MacKinnon, Catharine, A., 1979, Sexual Harassment of Working Women. New Haven: Yale University Press, 1979, pp. 123-131. Masson, Jeffrey, 1985, The Assault on Truth. 2d ed. New York: Penguin, 1985, pp. 56-69. Neu, Jerome, "What Is Wrong with Incest?" Inquiry 19 (1976): pp. 27-39. Russell, Diana, E., H., 1984, Sexual Exploitation: Rape, Child Sexual Abuse, and Sexual Harassment. Newbury Park, CA: Sage, 1984. Sociology, pp. 78-89. Tong, Rosemary, 1984, Women, Sex, and the Law. Totowa, NJ: Rowman and Allenheld, 1984, pp. 214-217. Lawrence, C. Becker and Charlotte, B. Becker, 2001, "sexual abuse and harassment." Encyclopedia of Ethics, Second Edition, Routledge, pp. 69-88. Mrazek, P.B. and Kempe, H. (eds) (1981) Sexually Abused Children and their Families, London: Pergamon, pp. 134-141. Polansky, N., Chalmers, M.A., Buttenweiser, E. and Williams, D.P. (1981) Damaged Parents: An Anatomy of Child Neglect, Chicago, IL: University of Chicago Press, pp. 89-99. Gil, D. (1970) Violence Against Children, Cambridge, MA: Harvard University Press, pp. 199-205. Giovannoni, J. and Becerra, R. (1979) Defining Child Abuse, New York: The Free Press, pp. 178-186. Elzinga, B.M., Phaf, R.H., Ardon, A.M., & van Dyck, R. (2003, May), Directed Forgetting Between, But Not Within, Dissociative Personality States. Journal of Abnormal Psychology, 112, pp. 237-243. Read More