Chapter IX - Post Traumatic Stress Disorder
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The purpose of this study is to examine sexual abuse, incest and memories, and the after effects that sexual abuse leaves on an individual.

Post Traumatic Stress Disorder - PTSD and other labeling.

As I said earlier sexual abuse could lead to a number of disorders and post tramatic stress disorder is an important one.

When a trauma12 is severe enough, it can create a lot of damage and the reality of the patient who has been sexually abused is more important than theory. The trauma is so destructive that it has to be recognized as the cause for the patient’s problems.

We should separate the bereavement theory, which is applied to other kinds of trauma like loss of a family member, lost hopes, lost safety, lost innocence as grieving our childhood, grieves that the world is not a safe place anymore etc. This grief is normal and most of our patients come to see us because of a trauma or a loss.

The label of Post Incest Syndrome, which combines Trauma Theory and Bereavement Theory with the specifics of sexual abuse, as defined in the DSM-IV.

Post Traumatic Stress Disorder concerns reactions to a “traumatic event that is generally outside the range of human experience”.

Some events frequently produce the disorder (torture) and others produce it only occasionally (car accident). The effects of some traumas are virtually inescapable. Incest falls into this category of torture. Rape is mentioned among the dozen of examples that can lead to Post Traumatic Stress Disorder, but not incest.

Although incest might easily be understood as rape (even if no penetration occurred) in terms of the violation that even touching can represent, it is not merely rape, it is ongoing, it is entrapment and it is done to a child by a person on whom they are dependent. People suffering from PTSD are often misdiagnosed as psychotic or even schizophrenic.

Psychiatrists address more the sexual aspect of incest and ignore the violation of the relationship, but psychotherapists are more attentive to work with the violation and the incest survivor’s after effects.

The following can be included in PSTD from sexual abuse:

  1. Women who have endured sexual abuse as children are in touch with survival spirit and magic. It is a way to protect themselves. It is where they can find their strength.
  2. The incest survivor often feels as if he or she is unreal and everyone else is real or vice versa. The simple worldview of the child creates two categories and splits them apart. The incest survivors never really trust their perceptions or their feelings, forever doubting themselves.
  3. Amnesia or blocking is the most common feature of Post Incest Syndrome, as we said it affects the memory, feelings and perceptions. It can result from the efforts the victim makes to separate from what is happening to them at the time of the abuse, or from techniques that they resort to after the abuse. This is achieved through dissociation.13 For many incest survivors the process of remembering after the initial acknowledgement is never complete.14
  4. Blocking out some period of childhood to eliminate unwanted memories the incest survivor may block some period of their early years (when the incest happened). The incest survivor always feels the loss of time and cannot remember the house or room or place where they were living and growing up.15
  5. Psychic Numbing. People who are forced to endure trauma numb themselves to the experience. They close off perceptual and emotional reception so that the event is not fully experienced. The feelings are dulled – they can remember details of abuse, but do not link any emotional response. Blocking prevents the survivor from facing and dealing with their pain, but it interferes with general life functioning and intimacy.
  6. Dissociation or Splitting.16 It is like a separation from the self or dissociation, like dividing good and bad into absolute separate realities that can never coexist. Dissociation can be an out of body experience “people can leave their body and float up to the ceiling”. Dissociations can easily become terrifying out of control and the manifestations can go from a continuum that ranges from a simple blocking of trauma to a fully developed multiple personality disorder.
  7. Partializing and Fantasy. During the dissociation some changes can occur. The child can develop a perceptual tunnel vision focusing on elements of surroundings (a picture, a light), to the exclusion of the rest of the experience. The child can retreat into fantasy expanding on what they see. These fantasies later become substitute or “screen memories” (Freud), which replace memories of the abuse.
  8. Creating other identities, friends, and alter egos (It is a kind of active manipulation of reality). The person is conscious and aware of what they are doing (before it becomes a multiple personality disorder).
  9. For protection multiple personality is the most inventive and occurs more that what we believe.

There are two more things that I want to add before closing this chapter, which happens frequently after sexual abuse and in the process of recovery.

  1. Crying After Orgasm. When there is intimacy with a partner the incest survivor can cry after or during intercourse. This reaction is like erupting from deep secret part of the soul stronger than the brain. When the crying happens, the person is flooded by feelings they cannot understand like pain, anger, confusion and fear. The reaction comes from the guts not the brain and the association is the one of arousal, abandonment and surrender. The body remembers: which leads to somatization.
  2. Avoidance and Loss of Interest in Sex. As sex is accompanied by confusion, anxiety, guilt and anger, the person cannot always associate it with their core. So they may not feel sexual anymore. They may loose interest in sex. They do not want to have sex, not to feel abandonment and humiliation like they felt so many times before.

In conclusion, addictions, self-injury behavior, obsessive-compulsive disorder, phobias, and panic attacks are all independent and full-fledged problems, but connected to incest and we must learn to associate these presenting problems with the consequences of incest.

Trauma literature documents both the vulnerability to revictimization and the proclivity to be abusive and violent in response to trauma (Van der Kolk 1987).

Both sides of this dilemma have been addressed. Herman (1993) emphatically disagrees with the frequently made statement that child abuse is bound to produce child abusers: “Contrary to the notion of a generational cycle of abuse…. The great majority of survivors neither abuse nor neglect their children….”. She explains that survivors on the contrary will often go to great lengths, mobilizing resources that they could not have mobilized for themselves to prevent harm coming to their children.

Others for instance Miller assert that, “Abuse begets abusive people. This is why battered children grow up to be mothers and fathers who beat their own offspring; from their ranks are recruited the most reliable executioners, concentration camp survivors and torturers. They beat, mistreat and torture out of an inner compulsion to repeat their own history and they are able to do this without the slightest feeling of sympathy for their victims because they have identified totally with the aggressive side of their psyche. The people were beaten and humiliated themselves at such an early age that it was never possible for them to experience consciously the helpless, battered child they were once were.” Alice Miller 1983.

12 Herman in 1992, said that trauma perpetrated by humans, can shatter the structure of the self and the organization of attachments. Thus the preexisting structures including the existence of the southing introjects can be largely disconnected by trauma and the dissociative response to it. Thus trauma itself induces problems with separation and separation anxiety.
13 Spiegel and Gardena in 1990 define disassociation as a special form of consciousness in which events that would ordinarily be connected are divided from one another….the defense is primarily one of separating into pieces what is normally a continuous pattern of consciousness and memory.
14 The essential feature of the dissociative disorders is a disruption in the usually intergraded functions of consciousness, memory, identity or perception of the environment (DSM-IV).
15 Spiegel. It is an experience of involuntariness. The experience of being made into an object, the victim of someone else’s rage, of nature’s indifference, noting the marginally bearable sense of helplessness, and realization that one’s own will and wishes become irrelevant to the course of events.
16 Epstein. In 1994 writes about cognitive experiential self-theory which poses two parallel and interactive systems. The experiential that is intimately associated with effect and the rational, which is not. There are two types of dissociation: that between the experiential and the rational system, which corresponds to repression and dissociation within the experiential system itself.