Some thoughts on a rather overdue apology from the Royal College of Psychiatrists

Some thoughts on a rather overdue apology from the Royal College of Psychiatrists – Position Statement PS04/26 – Addressing the impact of non-recent child sexual abuse on the mental health of adults.

Well, this is a long-awaited apology. In 1992, I sought help from psychiatrists in London. I’d got very depressed, had no job, no close friends and had sold the last of my book collection for a few quid. I was in an almost constant state of panic, felt I was a visible bother to people, and wanted to disappear. So badly did I want to disappear, I bought razor blades from Budgens. Luckily, they stayed unwrapped. Then I went for an assessment at Friern Barnet hospital, taking my father as ballast. As I wearily tried to explain my symptoms to a handsome psychiatrist, I mentioned that, at the age of nine, I had been sexually abused (or seduced), depending on your perspective, by my adopted brother, who was seven years older than me. The handsome psychiatrist merely looked embarrassed, and moved on.

Also in 1992, or thereabouts, Louise DeSalvo’s book  - Virginia Woolf: The Impact of Childhood Sexual Abuse on Her Life and Work was selling well in paperback. Phone calls to the recently established Childline were often about sexual abuse. And psychiatrist Judith Herman had just published a book -Trauma and Recovery - that would transform understanding of this area.

Back to Friern Barnet. ‘I think you have quite a big problem here,’ the handsome psychiatrist said, before prescribing me anti-psychotics which simply made my head feel like cotton wool.

I then went to stay with my parents in Sussex, and will always be grateful for the care I received from them. Another doctor in Sussex moved me on to antidepressants and beta blockers. Slowly, my mood lifted.

Later I returned to London, always with the hope that there would be some free talking therapy available so that I could discuss, in confidence, the issues that had sent me into such distress. But one doctor pronounced that psychotherapy with me would be a ‘waste of time.’ Meanwhile, the handsome psychiatrist told me that I was going ‘round and round on the same thing,’ (true), and that I ‘wanted everything done for me’ (not true). 

Then he told me he was leaving the hospital for another post. As usual, I’d got over-attached, even to someone who didn’t feel he was helping me much. ‘I don’t know what you’ve had,’ he said. ‘People come to hospitals when they’re unwell.’ Meaning I wasn’t. ‘I still don’t think you’re firing on all cylinders,’ he added.

I went back to the hospital once more, in 1995. It was a different venue this time, as Friern hospital had now become a luxury housing development. Given I was still unemployed, with no funds for private therapy, I asked, in some despair, whether there could be any support. The female psychiatrist looked me, sighed heavily, and said, ‘Sometimes we have to find the support for ourselves.’

All this nonsense upset me deeply for more than a decade. I felt confused, ashamed and on the scrapheap. The only positive thing to come out of the saga was a prescription for an old-fashioned antidepressant. And then later, thankfully, there was Prozac, with fewer side effects.

The Royal College of Psychiatrists now wants to apologise for the poor treatment given to those of us out there who are living with the effects of non-recent child abuse (NRCSA).

In her introduction to the position statement, Dr Lade Smith writes -

‘Despite a significant proportion of people in contact with mental health services having experienced childhood sexual abuse, it is not well enough recognised or responded to  - it is an issue hidden in plain sight. It will be seen throughout this position statement that survivors repeatedly state they are being made to feel as though the problems they have are inherent to them rather than being caused by the abuse they experienced.

NRCSA (non-recent child sexual abuse) is associated with higher rates of depression, anxiety, post-traumatic stress disorder and complex PTSD, psychotic illness, alcohol and substance use disorders, dissociative disorders, and eating disorders. People who have experienced NRCSA are also more likely to receive a diagnosis of personality disorder than those who have not been abused.

The Royal College  wants to move to a trauma-informed approach to the NRSCA population  - ‘a formulation that shifts the focus away from ‘What is wrong with you,’ to ‘What happened to you,’ and ‘What do you need right now?’ Psychotherapists could rightly argue that they’ve been working this way for years.

This is a fine paper, and I felt a huge sense of relief when it came out. It wasn’t just me who got treated like this! There are some powerful contributions in the paper from professionals. The two I most like are –

‘Working in a personality disorder service, I realised that almost every patient in the service had been sexually abused as a child. I became aware how, for many of them, the experience became an organiser of their internal structure – like a nexus around which they functioned.’

And,

‘Childhood sexual abuse is so frequent in the psychiatric population that it should be the bread-and- butter everyday work for psychiatrists and allied health professionals.’

Reading this paper sent me in search of a quote from Freud, first read by me in Jeffrey Masson’s The Assault on Truth: Freud’s Suppression of the Seduction Theory.

Let’s leave aside the thorny issue of why Freud abandoned his original finding that many of his adult patients had been sexually seduced as children. I’ve often been told by therapists that my relationship with my brother is ‘complicated,’ and indeed it is, but I’ve never felt secure enough to consider all the factors that make it so. Freud’s quote below, from the Aetiology of Hysteria (1986) has helped me to look at the matter again.

‘All the strange conditions under which the incongruous pair continue their love relations – on the one hand the adult, who cannot escape his share in the mutual  dependence necessarily entailed by a sexual relationship, and who is at the same time armed with complete authority and the right to punish, and can exchange one role for the other to the complete satisfaction of his whims, and on the other hand the child, who in [her] helplessness is at the mercy of this arbitrary use of power, who is prematurely aroused to every kind of sensibility and exposed to every sort of disappointment, and whose exercise of the sexual performances assigned to [her] is often interrupted by [her] imperfect control of [her] natural needs – all these grotesque and yet tragic disparities distinctly mark the later development of the individual and of [her] neurosis, with countless permanent effects which deserve to be traced in the greatest detail.’

(Quoted from Freud and the Seduction Theory - A challenge to the foundations of psychoanalysis by Jeffrey M. Masson.)

The report’s recommendations - better training for staff, fewer diagnoses dished out, avoiding re-traumatisation of those who turn up for help – are admirable, and I  really hope they are translated into practice. But I would still be unlikely to knock on the doors of NHS mental health services any time soon. I’d go elsewhere if I were looking for a trauma-informed response.