Today are we ready to understand and fully acknowledge incest?

As it is impossible to explore the constellation of symptoms that result from sexual abuse in all the countless permutations, however we are making enormous progress today. This subject is a very difficult and mysterious one in all the myriad of angles.

Elvin Semrad noted in a clinical aphorism, that much of individual clinical work has to do with acknowledging, bearing and putting into perspective intolerable affects.

Our profession as a whole is philosophically and clinically at the point of acknowledging the role of incest and sexual abuse in the lives of many patients, but it is perhaps not yet clear about how to bear and how to put into perspective this knowledge. “Putting into Perspective” includes in our view biological, evolutionary, cultural and political perspectives, perhaps entailing social and political action – areas where we as a profession have rarely tread.

What allows abuse to occur? This question is currently being actively engaged by clinicians and researchers (Oliver 1993). He invokes formulations based on Mahler’s developmental theories, and focuses on symbiosis and separation individuation disorders as the foundation of parental disposition to abuse. It pushes us to wonder about the origins, motivations and intentions of abusive behavior.

The mother’s role is highlighted, leading to neglect. The mother is responsible. She allowed this to happen, she didn’t protect her child. This was illuminated very clearly in my case history.

Let’s not forget that as therapists we are also confronted with the patient’s massive amnesias, difficulty in modulating affects and intense constriction of attention. These phenomena reflect the massive arraying of defenses needed to maintain psychophysical equilibrium.

There are numerous fascinating points that I discovered with my case study:

• The role of quest for the truth with different levels of conflict, which appeared. Once it has been established that sexual abuse has occurred, it is tempting for patients and therapists to define the goal of therapy as a quest for truth.
• After many years of repression, however a sudden onslaught of painful memories can overwhelm the adult incest victim with serious negative consequences.
• Furthermore knowing the truth is often distorted to mean discovering who is to be blamed with a hope that clarifying the issue will itself eliminate the pain of incest trauma and its psychopathological consequences.
• Some masochist’s patients love their agony and have difficulty to let go; it is love for some time. They are happy to have been sexually abused because… and then they do not know why…..? If the truth is confirmed disappointment results when the implicit promise of release and cure is not fulfilled.
• Therapist and patient are left to struggle with serious psychopathology; the incest trauma continues to work its effects in the patient’s mind.
• Moreover establishing the objective reality that somebody else was “at fault” externalizes the focus of therapy and leaves the patient’s inner conflicts unattended. They see the quest for truth as one of the goals of treatment, and that as a single-minded goal it sells the patient short. Just as an outpouring of emotions alone would sell the patient short.
• If the analyst who is dealing with sexual abuse does not keep abreast of how his or her actual behavior is affecting the abused patient, acting out may ensue and the working relationship will deteriorate.
• A profound confusion about fantasy and reality is one of the legacies of sexual abuse and more than with other types of patients, the analyst must be alert to the ways in which such confusion may appear in the analysis.
• Erotized transference can be a complication in the treatment. Patients who have been sexually abused as children inevitably view the analytic situation as sexual until proven otherwise and will repeatedly test out their expectation that analysis is seduction, until a sense of true safety is established.

These findings can provide an element of an explanation for why these patients are so vulnerable to exploitation and abuse by therapists – which unfortunately not only exists, but also is more prevalent than some people want to admit, however this very serious issue is not within the scope of this paper. What is very important and to keep in mind is the abused patients feel like victims and their goal is to emerge free from the secret and the shame.

Patients want to regain their power and their voice. They want the ability to be the nurturing, caring, trusting human being like other’s are. They do not want revenge but do want to prevent the perpetrators from doing what they did to them to anyone else. Patients want the ability to forgive and move on, recognizing that through the experience and the process of healing they are finding strengths they didn’t know they have.

Once the patients have truly healed, they do not have any expectations of their perpetrators. They have recognized that they are seriously impaired individuals who should find capacity for rehabilitation if it’s possible and ask for forgiveness.

I would like to conclude that some of the most important things in human life cannot be measured, they include: happiness, genuine feelings, memories, trauma and abuse. One of the challenges we face, as a profession is we have to gain more insights into questions of human existence. There will always be the discovery of problems that the standard practices of our profession don’t currently address.

We still have a long way ahead of us and the world is in need to discover another Freud. I am also a poet and I would like to add one of my poems that I think is appropriate to the conclusion of my paper. It is called:

“It Will Always Be”

It will always be
in the murmur of passion
It will always be
in what is not given
It will always be
in certain silence
It will always be
in starving for love
It will always be
in the back of human souls
It will always be
in the least expected
It will always be
in the dying of the night
It will always be
When it shouldn't be
That’s why
It will always be

A part of poetry is like psychoanalysis and therapy in the sense of it is awareness heightened to the point of love. It is a way of apprehending the intensity of being. It is to try to recreate experience more intensely, reduce it to a luminous whole, render intuitive the meaning and metaphysics of the universe and then feed itself and others to the kernel of being.