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The politics of child sexual abuse
In July of 1998 Psychological Bulletin published a meta-analysis of the long-term impact of child sexual abuse on college students. The article sought to debunk a belief that had gained widespread currency in mental health culture: that childhood sexual abuse was inevitably traumatic and inevitably led to later mental health problems. Most controversial was its suggestion that a morally neutral term such as "adult-child" sex might be used as the broadest rubric of investigation in this area, because child sexual abuse implies a particular and inevitable negative outcome. The authors argued that the mental health field has been governed by a bias toward viewing intergenerational sexual contact as inherently pathogenic, and that this bias has produced a highly narrow understanding of the association between child abuse and adult psychopathology.
The controversy that erupted in response to this article has been most frequently framed as a dispute between science and public morality. On the one hand, there are various professionals, victimsrights advocates, and moral conservatives casting Rind, Tromovitch, and Bauserman-the authors of the now infamous study-as recklessly neglectful of public morality. On the other hand, equally pious investigators are coming to their defense, insisting on the political and moral autonomy of science. Much like the polarized debate over the reliability of recovered memories of childhood sexual abuse in psychotherapy, neither position captures the complexity of the issues.
In this essay, we "unpack" the findings of the Rind et al. study, exploring key issues raised and placing them within a wider cultural context. While scientific inquiry is always embedded in a cultural and political framework, research that engages in redefining sexual boundaries is particularly rife with potential for arousing what has been termed "moral panic." Whether the issue is homosexuality, teenage sexuality, abortion, or rape, sexuality seems to carry surplus freight as a combustible topic. In recognizing that there is an element of hysteria associated with public outrage to the Rind et al. article, we do not mean to imply that there is no basis for criticism of this study. Indeed, there are legitimate bases for criticism. But our primary focus here is on what forces, historically and in this present, contribute to the subcurrents of this debate about it which are so easily obscured by the turbulence.
We agree, in part, with those critics, including Raymond Fowler, president of the American Psychological Association (APA), who have argued that scientists must be sensitive to the social implications of research findings, and that taking care in explaining controversial findings need not imply censorship. In the last two decades, incest and other forms of sexual abuse have been at the forefront of the women's and children's rights movements. Sexual violations have acquired tremendous social symbolic power in American political culture so that any challenge to the gains of these movements is perceived to be a threat to victims. But the controversy over the Rind et al. article stirs deeper uncertainties over the place of child sexual abuse in politics, the place of sexuality in children's lives, our understanding of trauma and recovery, the boundary between childhood and adolescence, and the place of scientific inquiry in adjudicating moral questions. We address each of these issues, attempting to steer a middle ground between a social constructionist or culturally relative position on sexuality on the one hand, and an approach that emphasizes universal principles of justice and care on the other.
Some of the controversy associated with the Rind et al. study involves hierarchies within science. Most social-scientific studies are modest in what they can claim. They are bound by the populations from which subjects are drawn, by the limitations of their measures, and by various additional methodological constraints. The power of the meta-analytical method lies in its capacity to rise above the terrain of a particular field, and to assess the overall strength of findings from a series of studies. It is, in effect, a study of studies, "meta" suggesting a more encompassing viewpoint, a higher level of analysis than that produced by the limited vantage point of a single investigation.
A Study of Studies
When performing a meta-analysis, researchers collect none of their own data, but sort through the data collected by others. In the Rind et al. metaanalysis, the researchers selected a sample of studies done on college students which addressed the issue of outcome from sexual abuse. In choosing which studies to include, they required that each study used in the meta-analysis meet certain minimal criteria such as adequate sample size, use of a control group, and a report on one of 18 symptoms they had identified. Previously, Rind and Tromovitch (1997) had performed a meta-analysis of community studies which showed that the effect size with regard to longterm adjustment is small. This means that, in community samples, those people who had been sexually abused as children were, over time, only slightly worse off psychologically than those who had not been sexually abused.
This newer meta-analysis of 59 studies of college students who had been sexually abused as children suggests that not all of them were still wounded by adulthood, not all of them were traumatized as children. While child sexual abuse (CSA) was associated with poorer adjustment, the magnitude of the effect, as in the community study, was small and, in the authors' words, "the negative potential of CSA for most individuals who have experienced it has been overstated" (p. 42). They also found that two-thirds of male CSA experiences and almost a third of female CSA were reported not to have been negative at the time of the abuse. Three of every eight male experiences and one of every ten female experiences were even experienced as positive at the time. When the long-term outcome was negative, it was difficult for the authors to figure out why because of so many confounding variables. In fact, family environment was found to be confounded with and to account for current adjustment in college students more than CSA.
The article was published in July of 1998 with little incident. It had gone through two revisions and two sets of reviewers before Psychological Bulletin saw fit to publish it. The drama that ensued drew its emotional strength from two primary sources: one was politically and religiously conservative anxiety over sexuality, and particularly homosexuality; and the other was psychology's professional concerns with maintaining social legitimacy.
It is not uncommon for fringe groups to seek out support for their causes in the scientific literature. Like the Bible, the scientific literature is vast enough to support a wide range of opinions and viewpoints. So it was not surprising that the North American Man-Boy Love Association, on their web site, seized this research as supporting their idealized view of the man-boy sexual relationship. Just as predictable was the moral panic of conservatives, gripped by the fear that homosexual pedophiles would, en masse, tear down legal and cultural sanctions against adult-child sex. Talk-show hosts like Laura Schlessinger as well as the Christian Coalition and the Family Research Council (a fund-raising group for conservative causes) began to rail against the article on the air. Matt Salmon, a Republican congressman from Arizona, denounced the article along with Florida Republican Dave Weldon at a press conference that the Family Research Council hosted.
Conservative organizations routinely monitor sexual research, looking for signs of relaxing sexual mores-signs which become associated with the weakening of social boundaries between the "good" and the "bad" elements of society. Sexual control becomes associated with social and moral order, but sexuality also becomes a domain where more diffuse social anxieties are imported. Public problems such as the widening of the income gap, the growth of poverty among youth, and the excesses of consumer culture, (problems the political right is highly resistant to address), are masked by the moral righteousness of sexual crusades. Indeed, one of the most important aspects of the meta-analysis was its finding that the effects of poverty and other broad indicators of family well-being outweighed sexual abuse as a factor associated with mental health problems in adulthood. But the heat of sexual hysteria readily obscures these less dramatic forms of "abuse." Poverty and neglect of children do not mobilize the same moral outrage in American society as does the specter of weakening sexual taboos.
Anxious about appearing "lax" on moral issues, the American Psychiatric Association eventually joined conservative organizations in calling for APA to retract the article. Matt Salmon even introduced a resolution to condemn the article in Congress and the House voted, almost unanimously ( 14 abstained), to condemn the article on the grounds that it gave a green light to pedophiles. After initially supporting the scientific validity of the article (Rind, personal communication, 1999), Raymond Fowler, the president of APA, retracted his support and in June wrote a letter to Congress denouncing it, saying that the article included opinions inconsistent with APA's views. He also set up a board to review future articles that have the potential to raise public concern.
In support of Fowler and the APA, Patricia Kobor, director of science and policy at the APA, argues that psychologists are "participants in a social contract with Congress and the public: if we don't work with them to explain how and what we are about, they can and will assume the worst and act on it. If psychological scientists value public support and federal funding for research, if they hope to be of some service to the common welfare, then we have to work with members of Congress and other groups, and we have to safeguard a reputation for straight talk and fair play."
Funding of psychological research is increasingly governed by a more conservative mood in the nation, rather than on more liberal principles of the "common welfare." Both psychology and psychiatry have a long history of dependence on the state, and particularly on its conservative wing. These professions gained initial prominence during World War I, with the testing and treatment of soldiers, and made monumental gains with the funding of training programs and research again after subsequent wars. Since the 1980s, an increasingly conservative political agenda dominates the funding of research, emphasizing biological over social causes and individual mental health over social change. While a cause like child sexual abuse unites politicians and psychologists, declaring one's opposition to child sexual abuse is a risk-free stance; indeed, only highly marginal organizations such as the North American Man-Boy Association defend such practices that others might call abuse.
It would be misleading to conclude, however, that all of the criticisms of the Rind et al. study emanated from a conservative political agenda. Some criticisms come from child welfare advocates fearful of a cultural swing in the direction of minimizing the impact of sexual abuse, just as there was a previous tendency in the mental community toward overstating sexual abuse as a single causal determinant of adult distress. The APSAC Advisor (a newsletter of the American Professional Society on the Abuse of Children) published a commentary responding to the uproar by pointing out that those in the sexual abuse research community have actually known for some time that a significant number of sexually abused children have no measurable long-term negative outcomes (KendallTackett, Williams, & Finkelhor, 1993). That does not negate, they argue, the responsibilities of clinicians to treat those who have been harmed. Taking issue with the interpretation of "small effect size," they point out the well known fact that we accept that smoking causes lung cancer while the effect size for this association is small and comparable to that of child sexual abuse to long-term psychological problems. These authors also point out that the meta-analysis only looks at one kind of outcome, mental health, and that there are other outcomes that may be measured as indicators of long-term trauma (for example, quality of life, successful adjustment, capacity for pleasure).
One of the more problematic critiques leveled at the meta-analysis is that victims may not be a reliable source of data on the effects of their abuse experiences. The authors of the APSAC critique argue that an abused child may learn from the abuser that such experiences are normal and positive, and accept the abuser's view of such events to his or her own detriment. They suggest that when considering outcomes, the idea that a child learns that adult-child sex is acceptable is, in and of itself, a poor outcome. This is an interesting critique because it brings up important issues of believability as well as multiple perspectives on the truth. Ironically, Rind et al. seem to be advocating "believing the child" (or, rather, believing the college student's perspective) when they argue that perhaps the term child sexual abuse should not be used to describe all forms of "adult-child" sex.
And, while Rind et al. argue that, on the one hand, college students are telling us that some acts we consider child sexual abuse may not be abusive, they also argue that "the findings of the current review should not be construed to imply that CSA never causes intense harm for men or women-clinical research has well documented that in specific cases it can" (p. 42). And although they embrace these two perspectives they reveal their own bias for a single cause or a single perspective by stating "classifying a behavior as abuse simply because it is generally viewed as immoral or defined as illegal is problematic, because such a classification may obscure the true nature of the behavior and its actual causes and effects." This notion that there is an "essential" reality that empirical investigation has the power to uncover belies their strongest argument: that sexual experiences are open to multiple meanings and interpretations.
Sexual Abuse Research in Historical Context
During the first wave of research on incest and child sexual abuse in the 1970s and 1980s, researchers routinely pointed out the relative paucity of literature on incest or child sexual abuse. Influenced by the children's rights and women's movements of that period, sexual abuse researchers had a sense of venturing into culturally forbidden territory, of finding what previous researchers and clinicians were not inclined to see.
Having won this ground, researchers and professionals on the forefront of the sexual abuse awareness movement have been understandably wary of assessing the costs of the victory. But there were costs, some of which emerged in zealous campaigns to ferret out histories of sexual abuse, whether in day care cases or in the history of psychotherapy patients. The mere suspicion or question of a history of sexual abuse seemed definitive evidence because the general thinking in the field throughout the 1980s was that the effects of a history of sexual abuse were denied, minimized, or otherwise concealed, and that the risk of "false positives" was negligible. It seemed counter-intuitive that children or adults would produce, or could be led to produce, disturbing sexual scenes or memories not based on actual abuse incidences. By the late 1980s, child sexual abuse had achieved a tremendous cultural potency as a primary cause of adult psychopathology, particularly for women.
Although in basic agreement about the trauma of sexual abuse, there was a tension between child welfare advocates who situated child sexual abuse as a family problem and feminists who described it as a product of a history of patriarchal oppression. The writing of child welfare proponents focused on public health, which tends to emphasize prevention and protection as well as therapy. Sometimes lumped together with issues of physical abuse and neglect, mothers as well as fathers were examined as perpetrators, and mother-blaming was acceptable practice in this literature. Mothers became the focus of blame for sexual abuse for "not knowing" and thus not protecting their daughters. While feminist responses were also concerned with protection of children and especially girls, the focus became the maniacal male, which produced an easy target for women's anger. Both feminists and child welfare advocates, however, were united in their use of the long list of symptoms from trauma to argue for greater child protection, more insurance benefits, and therapy for victims.
The rise of sexual abuse as a moral crusade coincided with changes in the mental health community and institutions as well. Women entered the field in growing numbers during the 1970s and 1980s, creating a more responsive mental health culture to female concerns. The expansion of the field and the growing public acceptance of psychotherapy meant that issues of happiness and wellbeing were taken seriously as mental health issues. But by the 1980s, restrictions on mental health coverage contributed to the movement to focus on trauma; extreme indicators of psychological distress displaced this earlier focus on "strains and stresses" (Haaken, 1998).
It could be argued that women's interest in child sexual abuse and the discovery of the commonality of abuse in women's histories paved the way for their greater voice and professionalization of therapy for abuse and victimization. But with the decline of an activist women's movement during the 1980s, the struggle of women against patriarchal control took on a more individualistic cast. The social problem of exploitation of women and girls was increasingly defined as a mental health problem.
With the decline of the broad-based social movements of the 1960s and 1970s, the mental health issue of child sexual abuse emerged as a unifying issue around which health professionals, women's organizations, and conservatives alike could organize. Right-wing conservatives were frightened by sex, whereas leftists and feminists were
Copyright Transaction Inc. May/Jun 2000
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