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"Hidden Pain: an insight into childhood sexual abuse" by Anne R. Lastman. Published by Freedom Publishing Co Pty Ltd. Available from Victims of Abortion, P.O. Box 6094, Vermont Sth, Vic. 3133. Ph: 0408 175 033. Price $30 includes postage within Australia. Reviewed by John Morrissey

The author of this study, Anne Lastman, came into contact with this problem almost by accident, in her work as a post-abortion grief counsellor. She found that child sexual abuse and abortion were often connected, and that in fact the scourges of early sexual abuse, abortion, pornography and prostitution are inextricably linked.

Hidden Pain is the result of her own findings from interaction with her clients and an extensive survey of the relevant current literature of research. Her analysis contains a spiritual and theological dimension, as well as the purely scientific and secular one to which this review will be confined.

Although so much public attention has been focused on clerical and institutional abuse, this author is at pains to point out that the overwhelming proportion of offences occur in the home and especially to young girls (viz the recurrence of feminine pronouns), her point of contact with victims being the consequences of the trauma in their later troubled lives, which might include multiple abortions. When a biological father, in particular, turns his back on his role as protector of his daughter to become her abuser, this inversion of the natural order is particularly damaging for her sense of personal worth, identity and place in the world.

The study begins with an explanation of terms, such as suffering and trauma, and moves on to an examination of sexual abuse and its effects. Later chapters describe treatment or healing of the victims, while the work concludes with three self-reported case studies, which readers will find particularly confronting, as the voices of the victims emerge from these pages and their heartfelt gratitude to Anne becomes apparent.

We learn that the psychological wound which we call trauma results from some overwhelming event, be it a threat, blow or even witnessing something, and that this is processed in the minds of children in a number of different ways, but without the coping mechanisms learned by adults. As this writer explains, "Traumatised victims always attempt to regain mastery or control over their lives following the trauma. These individuals are afraid of again not having control or relinquishing any form of control which they have established since the trauma occurred, so unconsciously they resist movement which would take them away from their known [abuser]".

Without healing, to put together their lives, this loss of trust, relationship and security becomes a recurring memory in a "fractured soul". It requires only a flashback to trigger the response. This may manifest itself in isolation, substance abuse, violent behaviour, risk-taking, self-harm or vulnerability to other threats, perhaps leading to suicide.

Sexual abuse is damaging because an adult crosses an "invisible barrier into the sacred space of a child who is usually dependent or even trusting of that adult". This confuses "personal identity, space and boundaries", the effects lasting a lifetime. It creates a loss of understanding of right and wrong, and a loss of trust, along with a sense of abandonment from this premature sexualisation. This is a form of the Stockholm syndrome, as a need for survival effects a traumatic bonding with the abuser.

A loss of trust in those she is supposed to love and trust most of all, results in an "insatiable ongoing need to become visible to the world because the abuse was happening to her and nobody saw what was going on." The author's diagnosis: multiple abortions, promiscuous behaviour, alcoholism, drug use and abuse "speak to me about someone who is crying out to be seen", to be made to feel OK about herself. Both in published studies and the author's own casework, "re-victimisation" is a consistent finding. Even anorexia and bulimia can be a refusal to permit her body to grow into womanhood, so that no-one will desire her.

In a separate chapter on victims, males do receive some attention. In some Australian studies, 90% of females and 80% of males experiencing sexual abuse before the age of 15 years knew the perpetrators, mainly fathers, stepfathers and other male relatives. However, it has also been reported that 24% of male and 13% of female victims have been abused by known females. Researchers found that abused boys tend to identify with their aggressors and [some] later to become abusers themselves. However, females tend to be attracted to partners who continue the abuse, rather than those who will honour and respect them. This is feeding their low self-esteem, a need for relationships which continue to demean them.

One of the basic consequences of trauma from child sex abuse is the loss of a "safe place", and a consequent withdrawal from painful memories. We are told that healing requires acknowledging past realities, "with all their ugliness", in order to trace fears, behaviours and difficulties to past abuse. Not allowing the past trauma to be processed and recorded as an explicit memory leaves it frozen in time, to be triggered again and again.

Drawing on her case studies, Anne Lastman quotes individuals feeling "broken", "empty" and "having parts of me lost forever". They ask questions like, "If God exists why does [H]e allow little girls or children to be abused...?" Guiding clients back from their "safe place", she emphasises the need for physical and emotional safety, trust and a surety that they are ready to return to the source of the pain.

There follows a brief but insightful chapter on the perpetrators themselves. Once outed, the incestuous molester finds his life destroyed, without social supports, perhaps loss of home and employment, and with any police involvement threatening the dangerous environment of prison. Surprisingly to some readers, the author sees reconnection with the family as desirable. Nevertheless, working through her emotions, the victim may pass through defending him to hatred and even thoughts of revenge.

Other concluding chapters briefly refer to clerical abuse and ritual abuse of children, but it is the appended case studies which are the most confronting sections of this work. Three anonymous clients tell of their experiences of incest in quite some detail, and how it affected their lives afterwards, their marriages, their break-ups, their addictions, abortions and ongoing relationships with family members. All tell of the healing experience of working with Anne Lastman, and their expressions of gratitude are fitting praise for her commitment, empathy and expertise.

Hidden Pain is a valuable contribution to our understanding of child sexual abuse, the precise harm inflicted and the way back from the ongoing effects of trauma. It is repetitive in parts - perhaps to emphasise the point - but in no way light-weight. Rather, it is dense in content, with a table of contents and a bibliography which would qualify it as a reference text for tertiary study.

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