Childhood sexual abuse: ‘If you would see true courage, look at the survivors’

One of my ethics teachers had strong views that stuck with me. ‘Evil hides wherever you do not look for it,’ he said.
 
True to this dictum, most of the people who have abused children I have met in my work as a long-time GP were hiding in the open. They were often pillars of society and very good with children. They wanted to be so respectable that everyone would doubt that they were capable of such things.
 
The concept of ‘stranger danger’ is so off the mark, in my experience.
 
People who abuse children are rarely strangers. More often, they are members of a family or very well known to the family whose trust they betray. They tend not to use aggression – initially, at least. They instead rely on a variety of cruel strategies and nasty tricks, playing on the power imbalance between adult and child.
 
For my fellow GPs: if you see a child whose school performance has suddenly deteriorated or who suddenly become indiscriminately aggressive or who acts in an overly sexualised manner or who suddenly becomes self-harming or excessively hygienic or excessively unkempt, find out why.
 
Do not put their problems in the ‘too hard’ basket. Look, listen and offer assistance. Seek advice.  Refer to appropriate local services.
 
Most of all, if a child reveals anything that sounds like inappropriate behaviour from an adult or post-pubertal teen – seek urgent advice. Do not ignore it. You may have detected a paedophile’s actions. Acting now may not only save the child in front of you but so many more other victims.
 
Childhood sexual abuse is not rare. For 70 years, surveys have indicated that 10% of people report an unwanted sexual experience from an older person before the age of 13 years.
 
But many people do not speak out about it until later in life, if at all.
 
Many times, I have had adult patients come to me with recurrent trivial issues provoking huge anxiety, or sexual dysfunction. They may be overprotective of their children, or have a resistance to bringing children into the world. They may have chronic non-specific pain, insomnia or drug dependency.
 
Whenever a patient like this comes to me, I know something else may be at work.
 
I listen and wait, support and offer what I can: comfort, simple suggestions and structure. I have learnt to wait for the time when they trust me enough. When I judge that the time is right, I ask something like: ‘Is there anything old or new bothering you? Something that you have not yet mentioned?’
 
It is so important to make space for people to come forward, if they want to.
 
I’ve seen what can happen otherwise.
 
Growing up, I saw too many die before 30 from drug overdose, single-vehicle collisions and suicide. I did not know why they died then, but I do now.
 
And now, I see too many whose personalities are damaged, who suffer from what looks precisely like post-traumatic stress disorder.
 
I see isolated people who find it all but impossible to maintain a close relationship or a steady job. But they survive.
 
If you would see true courage, look at the survivors. Every day is a victory.

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