Sexual Abuse Reading Centre

Beyond Betrayal - Issues of Grief and Loss for Survivors of Sexual Abuse

by Deborah L. Guzinski

You can't grieve what you can't feel...

Dealing with a recent, significant change in an important relationship has made me more aware of the difficulty I have in dealing with loss, the feelings of anxiety and fear, the pain that becomes overwhelming. I fall back into a victim mentality, feeling as if everything I do is wrong, that I will never be good enough for someone to love, and that I can never trust anyone to stay. As I have moved through the cycle of denial, anger, bargaining and back to denial, I find myself "numbing out", both emotionally and mentally, gradually slipping into depression. This has had an averse effect on my ability to work, study and relate to others. After repeatedly asking myself why I'm having so much difficulty coping with this loss, I have come to realize that the loss of a relationship in the present has triggered feelings of loss from childhood. What should be manageable now becomes unmanageable when coupled with issues from the past. It has become apparent that any significant loss, any loss that touches the wounded child in me, can become an occasion for complicated grief. The following words are from the refrain of a song relating the experience of child sexual abuse. They accurately portray the intense feelings of loss and grief for the survivor.

The trouble with me,
I can't seem to trust.
My wounds just bleed and won't heal up.
I don't know where I'd be
If I'd never been touched.
But I know I don't like me much.
 
(Quoted from: The Trouble With Me, by Michael Kelly Blanchard)

Bradshaw refers to the damage of child sexual abuse as "soul murder" and a "hole in the soul." Tessier says "childhood sexual abuse affects us at the core - at the very deepest center of our reality" ⁽¹⁵⁾. She refers to this core as our "shattered soul." One survivor has described her experience this way:

Abuse shatters the spirit, so there's nothing left. I often think of myself as a house that has been hit by a tornado. The structure is demolished, all the pieces are scattered around. So you try to rebuild, but some of the pieces are destroyed - too broken to use again. And some of them are missing. So you can't ever get it back the way it was.^{(Tessier 16)}

For me, it seems more accurate to describe it as a black hole in my inner space, a great void at the center of my being that seems to have the power to pull the good experiences of my life into its darkness. No matter how we attempt to explain the pervasive effects of child sexual abuse, "we must understand that a death has occurred. More than childhood lost or innocence destroyed, our spirits, our selves, our structures of existence have been shattered, and new life requires rebirth" ^{(Tessier 21)}. But there can be no rebirth without first grieving the losses.

Buried grief poisons, limiting your capacity for joy, for spontaneity, for life. An essential part of healing from traumatic experiences is to express and share your feelings. When you were young, you could not do this.

First, however, it is helpful to have an understanding of the grieving process itself and the role it plays in recovery from loss. Worden defines four tasks of mourning he sees as necessary for recovery from loss. The first is to accept the reality of the loss. An inability to do this is denial. The next step is to experience the pain of grief. It is necessary to allow yourself to feel the pain. Worden quotes John Bowlby as saying: "Sooner or later, some of those who avoid all conscious grieving, break down usually with some form of depression" ⁽¹⁴⁾. The third task is to adjust to the environment in which the deceased (or object of loss) is gone. Failure to accomplish this task causes an inability to adapt to the changes brought about by the loss. The last task is to withdraw the emotional energy from the loss, to let go and begin to move on to new relationships ^(11-16).

Worden indicates the following feelings are common in normal grief: sadness, anger, guilt and self-reproach, anxiety, loneliness, fatigue, helplessness, shock.. yearning, emancipation, relief and numbness. He points out, however, that if any of these feelings continue for unusually long periods of time and are extremely intense, it may indicate a complicated grief reaction ⁽²³⁾.

When someone fails to move normally through the tasks or stages of grief, it is known as complicated grieving. Cook lists five warning signs of complicated grieving. These include avoidance of grief, chronic or prolonged grief, delayed grief caused by previous unresolved loss, inhibited or repressed grief, and psychiatric illness such as clinical depression, anxiety, or post-traumatic stress disorder ⁽⁴⁷⁾. In addition, certain conditions indicate a higher risk for complicated grieving. These include a "history of family dysfunction, resulting in a lack of coping skills and/or low self-esteem," inadequate support system, history of multiple losses, psychiatric problems, "psychosomatic illnesses, indicating that the client has a habit of denying intense emotion," a "suffering life script, indicating that the client ... expects continual waves of misfortune in life," drug abuse or addiction, controversial loss, ambiguous losses, problematic relationship with the deceased, and secondary gain by not grieving. ^{(Cook 48)}

In his treatment of adult survivors of childhood abuse, John Bradshaw identifies stages of grief very similar to Kubler-Ross. He refers to this particular level of grief work as "original pain work" ⁽²¹²⁾. In dealing with loss issues of childhood abuse, he indicates that:

Grief work begins with shock and denial. It proceeds to a kind of bargaining, then to anger, guilt, remorse, sadness, hurt and finally acceptance. In truth, most of us have been stuck in the grief process all our life. We have been stuck at the levels of shock and denial. This is why most adult children have a low grade chronic depression ⁽²¹²⁾.

Before we can fully appreciate the importance of the grieving process for adult survivors of sexual abuse, we must understand the dynamics and long term effects of this abuse. Various statistical data offer conflicting estimates on the scope of this problem, ranging from 15% to 38% of all women in the United States having been victims as children^{(Bourdon 7, Tessier 11)}. From these reports, it seems reasonable to assume that approximately 25%, or one in every four girls, has been or will be sexually abused before the age of eighteen.

In the majority of cases, the perpetrator is a family member or close family friend. As Tessier points out, the issue for the victim is one of trust. She quotes E. Sue Blume as saying the abusive act "violates an ongoing bond of trust between a child and caretaker" ⁽¹²⁾. According to Fredrickson,

During sexual abuse, children feel and incorporate the rage, pain, shame, and sense of perversion that the perpetrator is projecting. They take these feelings into the very core of themselves, and they are badly traumatized by the emotions surrounding the assault, as well as by the assault itself. ⁽⁵⁹⁾

Typical survival mechanisms are dissociation and repression. Tessier describes dissociation as "the part of her that is being abused remains behind, and she goes 'out' - out through the ceiling, through the top of her head, through the daisies and into the wallpaper - out..." ⁽¹⁵⁾. The victim distances herself both mentally and emotionally from the experience, disconnecting herself from the act, the perpetrator, the fear, the pain, and even from herself. In much the same way as people describe life after death experiences, there is the sense of unreality. as if the abuse is happening to someone else. "Dissociation gets you through a brutal experience, letting your basic survival skills operate unimpeded ... Your ability to survive is enhanced as the ability to feel is diminished" ^{(Fredrickson 59).}

In addition to dissociation, the victim frequently represses memories of the abuse. For a child, who cannot possibly comprehend what is happening, not remembering becomes the only way to survive the violation and betrayal. These survival mechanisms are encouraged by the abuser and by the nature and circumstances of the abuse. Keeping the secret becomes very important. The child is often coerced into silence by fear of the consequences to herself (no one will believe her), to the perpetrator (who is probably someone she trusted and loved) , and to her family (what will happen to them if daddy or brother or uncle or grandfather is exposed). So the dissociation and repression are reinforced by the shame and secrecy. As Bradshaw indicates, "the greatest problem with physical/sexual victimization is that victims cannot express their fear, hurt and anger. The incest victims are in a true Catch-22. If they tell, they risk losing their family." ⁽¹⁴¹⁾.

Keeping the secret, dissociating from the experience, and repressing the memories all serve as important survival mechanisms for the child. However, when these behaviors continue into adulthood, problems eventually arise. Fredrickson points out that for the unconscious, there is no awareness of past, only present. So when the memory of abuse is repressed or buried in the Guzinski 8 unconscious, it is preserved as "an ongoing act of abuse in the present reality of the unconscious mind ... the mind does not know the abuse ended" ⁽¹¹⁷⁾. Repression and dissociation hide the memories, but the feelings keep coming back. Without an understanding of the causes, the lifelong effects of depression, anger, low self-esteem, anxiety, and guilt continue.

Sexual abuse is an act of violence. The victim is violated, betrayed, invaded. The nature of the abuse fosters secrecy, which adds to the devastation and hinders the opportunity for protection and healing. Bradshaw and Bourdon both indicate that many survivors suffer from Post Traumatic Stress Disorder. According to Bourdon,

PTSD is the result of a traumatic experience that is outside the range of normal human experience and manifests itself in symptoms such as recurrent or intrusive memories. distressing dreams, flashbacks and a reexperiencing of the traumatic event ^(10-11).

Grief is a natural human response to loss and betrayal, but the dynamics of sexual abuse deny the survivor this opportunity for comfort, healing and resolution. Survivors frequently come from dysfunctional families. lack strong support systems and have learned to deny emotions due to repression or dissociation. But you can't grieve what you can't feel. In addition, the loss of self-esteem, as well as the shame and guilt the survivor experiences, create the feeling that she is only eligible for bad things. The shock of the betrayal and violence generate a "chronic sense of sadness and grief" ^{(Bradshaw 121)} . Flashbacks and nightmares may be symptoms of Post Traumatic Stress Disorder. The various reasons for secrecy provide "secondary gains" for not grieving. Referring back to Cook's warning signs and factors that put individuals at risk, it is very apparent that adult survivors of sexual abuse are probable candidates for complicated grieving.

Lucie S. Bourdon has conducted a study into the grief and loss reactions of adult survivors of sexual abuse (ASSA) to determine the nature of losses, the experiences of grief, and how their responses compare to other non-death grievers. She uses Parkes' definition of grief as ". . essentially an emotion that draws us toward something or someone that is missing. It arises from an awareness of a discrepancy between the world that is and the world that 'should be' . " She continues that "bereavement occurs when one is unable to depend upon one's former view of reality - when one's assumptions about the world are shattered" ⁽²⁷⁾. When applied to the condition of ASSA'S, and in light of my personal experience, this seems a very appropriate definition.

Data for Bourdon's study was compiled through the use of the Grief Experience Inventory-Form B and a Loss Questionnaire which were completed by three groups. The first was a group of ASSA, the second or Norm group consisted of non-death grievers (divorced or Guzinski 10 separated adults, parents of handicapped children, and adults who have institutionalized their parents) , and the third was a group of therapists who have treated ASSA. The Grief Experience Inventory consisted of 104 true/false statements designed to determine grief responses in the areas of denial, despair. anger, social isolation, loss of control, somatization, death anxiety, sleep disturbances, physical symptoms, optimism/despair, dependency, atypical responses, social desirability, loss of appetite, and loss of vigor. According to Bourdon, "in all cases, ASSA experienced a higher degree of loss than the Norm group" ⁽⁴⁷⁾. Table 5 is a comparison of the ASSA and therapists responses to the Loss Questionnaire. These questionnaires listed twenty different possible losses for ASSA, based on development, relationship, sexuality, self-esteem and general losses. The possible responses were "never applies to me, slightly applies to me, moderately applies to me, and completely applies to me" ⁽³⁴⁾. Most responses fell into the moderate and complete categories, indicating the impact of these losses on ASSA. In addition, each respondent was asked to rank the three most difficult losses they had experienced. The results indicated that the five most difficult losses were loss of the ability to trust, loss of selflove, loss of self-identity, loss of self-respect, and loss of the ability to experience feelings ^(55-57).

The study also indicated that survivors who experienced abuse before the age of eight showed higher total loss scores, especially in the areas of development, sexuality and self-esteem ⁽⁷¹⁾ . This finding supports Erikson's stages of psychosocial development. His theory states that through successful completion of the first three stages (ages 0-5) a child develops trust, autonomy and initiative. Failure in these stages results in mistrust, shame and doubt, and guilt. According to Bourdon, "ASSA's perceived losses of protection and of childhood innocence, as well as other losses in the 'development', 'sexuality' and 'self-esteem' categories imply that these three basic tasks were not met" ⁽⁷²⁾. Although "age when the abuse began" showed the most consistent effect, there were a number of other variables influencing the types of losses experienced. These include how long the abuse lasted, use of coercion, number of perpetrators, and the relationship to the perpetrator ^(71-74).

As a result of her study, Bourdon states the following conclusions:

These results provide ... evidence ... that certain aspects of a survivor's development, formation of interpersonal relationships, feelings about her sexuality and ... her self-esteem are compromised early in childhood. This finding, coupled with high grief scores of ASSA on the GEI-B, have strong implications ... Currently 'grief work' is but a small aspect of treatment. The findings from this study suggest that the social, physical and emotional manifestations displayed by ASSA are signs of pathological grief ... a large part of treatment of ASSA is grief therapy. (77)

As Bass points out, "grief waits for expression. When you do not allow yourself to honor grief. it festers. It can limit your vitality, make you sick, decrease your capacity for love" ⁽¹²⁰⁾ . It is apparent from Bourdon's study, the opinions of professionals and my own experience that survivors of sexual abuse endure many significant losses and must be encouraged to acknowledge and grieve their losses as they work toward recovery. Sharing with a counselor, joining a support group (for reassurance that others have worked through this so I can too), and looking into the background of the perpetrator (for possible answers to the question of why this happened to me) can be extremely beneficial. There are many ways of externalizing the pain and grief. Writing a letter to the perpetrator, even if it's never mailed, can be very helpful. One survivor found emotional release by reading her letter to her support group and then burning a photograph of her perpetrator. Bradshaw encourages developing a nurturing relationship with the wounded inner child, getting in touch with the pain and learning to comfort yourself and to accept comfort from others.

In her article on survivors of sexual abuse, Tessier quotes a suggestion by Linda Sanford in Strong at the Broken Places. She refers to the tremendous impact the Vietnam Veterans Memorial Wall in Washington, D.C. has had for so many people. It helped bring about "the end of national denial and the beginning of mourning over the war." Making a comparison to the need to end the denial and encourage mourning for survivors of sexual abuse, Sanford suggests:

We need a wall for survivors of childhood trauma. There we could grieve in good company. Lacking such a memorial to the horrors of childhood trauma, we have,. instead, living memorials to the survivors who "prove" the myth of "Once damaged goods, always damaged goods."

Works Cited

• Bass, Ellen and Laura Davis. The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse New York: Harper Collins Publishers, 1992.
• Bourdon, Lucie S. Grief and Loss in Survivors of Sexual Abuse. M.S. Thesis, Colorado State University, Fort Collins, 1991.
• Bradshaw, John. Bradshaw on the Family: A New Way of Creating Solid Self-Esteem Cook, Alicia Skinner and Daniel S. Dworkin. Helping the Bereaved: Therapeutic Interventions for Children, Adolescents, & Adults. New York: Harper Collins, 1992.
• Fredrickson, Renee. Repressed Memories: A Journey to Recovery from Sexual Abuse. New York: Simon and Schuster, 1992.
• Tessier, L.J. "Tess". "Women Sexually Abused as Children: The Spriritual Consequences." Second Opinion 17 (Jan. 1992) : 11-23.
• Worden, J. William. Grief Counseling and Grief Therapy; A Handbook for the Mental Health Practitioner. New York: Springer Publisher, 1982.

Copyright © 1994 Deborah L. Guzinski. Used by permission.

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