A NEW SETTING FOR THE SEXUALLY ABUSED CHILD (2002)

International Conference "Clinical Sándor Ferenczi", Turin (Italy), 18-21 July 2002.

When incest is put into action between an adult relative and a prepubescent child, the sexual trauma is at its height. There is then a danger of a confusion between the sexual-passionate put into action by the adult and the basic demand for affection and trust coming from the child. Confusion of the two languages of love, contradicting each other, one sexualized, the other not. Confusion of the symbolic of parenthood, primordial domain of filiation, and thus of humanization, with the universe of adult genital sexuality that is unfamiliar and unknown to the child, and the perverse games of adults. Sandor Ferenczi theorized this clinical work unambiguously, beginning in 1930.

Several key moments in the therapy of little Sabine will enable us to illustrate the principles of our therapeutic action, when faced with a little girl who has been gravely traumatized, raped.

It is a matter of establishing a modification of traditional therapeutic settings, in order to create conditions adapted to this type of abusive family whose pathology is mainly made up of toxic bonds between generations.

The theoretical support of my presentation will be that of a current reading of great classic texts of Freud and Ferenczi, of their correspondence and of some other modern analytical and systemic works.

I. Psychical commotion

In his 1932 work, Ferenczi theorized, as we all know, the notion of "Confusion of languages between adults and the child". This has to do with cases reported in his Clinical Journal, going beyond the idea of "parental hypnosis". He then invokes the notions of terrorism of suffering, of the difference between affection and passion, but above all the notion of an interiorization of guilt by the child as an introjection with multiple consequences, when a child has experienced the violence of incestuous acts.

In effect, in the case of little Sabine, as in most of these highly pathological families, it is the prohibition of the incestuous ACT which has been transgressed by her paternal grandfather and by her father. Here the prohibition does not have to do with a prohibition against incestuous thought or against the desire of one or the other, nor even speech alone, not even when it is of the provocation-allusion-invitation sort. It has even less to do with the incestuous dream, or an incestuous theme within a delusive syndrome such as hallucinations or interpretations. No, it is a matter of a psycho-sexual shock, a "sexual fright, ("Sexualschreck", in Freud’s terminology), a psychical commotion (Erschütterung, in Ferenczi’s terminology), and its immediate effects, both physical and moral. These effects upset this child’s drive world, thus greatly endangering his or her future. These children are EXPOSED, from the moment of their birth, just like "unwelcome children". This is a euphemism in Ferenczi’s work ; we know that it often refers to more or less failed attempts at infanticide, violent abandonment, or multiple forms of torture along with death threats and emotional blackmail. In 1929, Ferenczi will advance an original notion about this: if the child doesn’t die right away, his death drives, disintricated because dis-objectalized, will first be unleashed against himself (Unwilkommen Kind und sein Todestreib).

Sabine was raped for the first time around the age of three or four, as were most of the minors treated by us for a number of years at the Centre des Buttes Chaumont. When we receive her in therapy, the little girl is in great distress, and she will seek to put a stop to the situation she has undergone, but without being able to say so clearly. The abuser, paternal or maternal, shows no sign of feeling guilty, and all possible mechanisms are at work to camouflage, minimize and deny the act for which he is nevertheless responsible. Not only does the abuser not own up to his act (except, in exceptional cases, before a Tribunal), but he will not hesitate, with consummate hypocrisy, to accuse the child of three or four of having provoked him sexually!

But the death threats are what dominate the adult’s hypnotic arsenal against the child. The obedience to the order to remain silent condemn the victim to silence regarding the facts of what she has undergone, and if nothing is set up to help her, the tragedy this child is experiencing will quickly be transformed into a dissociation of her identity. (D.I.D)

The necessary help, as we shall see, cannot be limited to an individual child psychotherapy. First, a medical, social and legal arsenal will be needed, and a net psychotherapy integrating the child’s environment.

For this, the creation of a pluri-referential therapeutic setting seemed to us indispensable.

Indeed, we observe, after Ferenczi and with him, that what will make the child’s trauma particularly pathogenic is the disavowal of this child’s speech about this reality itself, and by the very entourage in which the child has placed the most confidence (Kinderanalyse mit Erwachsenen, 1931). One day he will try to confide his secret to his mother, an aunt, a cousin, a neighbor woman, but as the universe of disavowal dominates the exchanges in this pathogenic constellation, the psychical situation of the child is comparable to that of a hostage. He will then manifest a syndrome comparable to the adaptation syndrome seen in adults, known as the Stockholm syndrome.

The child who survives after having been mistreated, abused, hypnotized, conditioned by a close relative (paternal or maternal, and sometimes both), becomes a victim who is the emissary of his family system.

In the psychoanalysis of an adult, we are faced with what remains of the childhood trauma that occurred twenty or thirty years earlier. "Traumas have to be deduced," wrote Freud to Ferenczi (letter dated September 16, 1930), referring to adults.

I cite Freud: "The new views about the fragmentation of mental life that you indicated, seem very ingenious to me, and have something of the great characteristic of the theory of genitality. I just think one can hardly speak of trauma in the extraordinary synthetic activity of the ego, without treating the reactive scar formation along with it. The latter of course, also produces what we see; thus we must make the trauma deducible."

There is in these cases the "reactional scar formation" Freud speaks of, the "autoplastic" adaptation, as Ferenczi called it. Today the notion of "resilience" borrowed from the physical sciences enables us to give an account of what the child-victim has survived, when the moments of distress could be surmounted. As a psychoanalyst of adults, we can then measure the psychical price of the mismanagement of the trauma at the time of its occurrence.

II. Baby-Yuck

At the age of six, SABINE is referred to us for a phobia of water, dangerous acts of violence against her classmates, troubling depressive periods and an intense compulsive masturbatory excitation. She has been placed in a foster family by court order, and everyone there is overwhelmed. Her paternal grandfather has been incarcerated for six months for physical abuse, while the whole dossier attests to charges that Sabine and her younger brother were made to perform fellatio. The grandfather, in the sort of atmosphere typical of physical violence, engaged in such practices with the two children. But the legal qualification of these acts as incestuous oral-genital sexuality was not recognized by the tribunal, and the matter therefore went before the magistrate, where punishment will only be relative to the physical violence, due to blows and mistreatment. Here we are faced with a form of disavowal of the child’s speech by the Justice system, which qualifies only the most commonplace part of the abuse, ignoring the perverse sexual practices the child has endured.

In each session of this kind of therapy, a new setting is formed to protect the two children. At each session there are two therapists (a man and a woman), every month, in the presence of the foster family (designated as Mommy and Daddy) and the social workers who are responsible for each of the two children. Thus we set up a net therapy in which the participation of each of the caregivers is indispensable, for these children who are flayed alive can then feel safe. They talk, play, draw, explore the space, play-act their conflicts through their immediate transferences. The social workers loosen up and start to talk. For example, in the case of Sabine, we learn one day that the children’s legal father has been deprived by the court of the right to house, despite never having been inculpated. And why is this? we ask. Because he too has been named by Sabine as the perpetrator of these same acts on Sabine and brother. We were, of course, unaware of this.

He is an example of a particularly rich session.

Several sessions have already tested our protective net in its stability and its pluri-referential continuity. One day, in the course of her therapy, Sabine spontaneously draws a complete set of carrots in increasing sizes.

A tiny carrot, of which she says, "That’s my little brother."

A big one, of which she says, "It flies – that’s my father."

One still bigger, which she calls, "Big Grampa Yuck", the grandfather.

Lastly, a giant carrot : "That’s me," she says.

We can immediately detect several aspects of the phallic signifier, under the aspect of memory and consecutive fantasmatic elaboration. The erection designated as "the flying carrot" related to the father, the notion of nausea (disgusting phallus linked to urine, sperm in the mouth?) identified with the grandfather and, as a counterpoint, the brotherly penis, which has no sadistic, phallic or erectile connotation. The little brother a wholesome carrier, with no associated eroticism ; this is sexual difference in its immediate childlike simplicity.

She herself, by means of a reactional elaboration to this traumatic upset, will encode the image of her own body, through a defensive function of this primary post-incest fantasy, here drawn as a giant carrot (girl as phallus), who qualification as "giant" evokes her attempt at constructing an ideal Ego-I.

What she has experienced as non-sense must be compensated by this megalomaniacal fantasy which is the trace of the castration complex, "what remains after the threat of castration," following a definition of fantasy by Freud (An Outline of Psychoanalysis). In this family, death threats were part of daily life, in the form of blows, the fear of being drowned in the bathtub, humiliation and pedophiliac sexual exploitation. If the oral-genital act is considered as having involved the penetration of the child by the mouth, it is then legally defined as a crime, and thus as one of the forms of incest put into action.

For Sabine, the phallic function relative to the paternal line (grandfather and father) was perverted to such a degree that her problems in the foster family attained a great intensity. In the course of the therapy, we will gradually discover her instability, insomnia, hypomanic state of agitation and sexual provocations directed at every adult she meets. This is one of the specific features of these pathologies of identity disorders. When a part of herself (the grandfather in her) will replay in an active mode what she experienced passively; Sabine, like a genuine polymorph pervert will turn her drives around from passive into active, and also turn them back against herself by placing herself in danger of being killed, as does her brother also, doing acrobatics on the railings.

Indeed, Sabine will not limit herself to mimicry, to the simple imitation of her forbears’ sexual perversion. She will innovate across the whole gamut of possibility in a polymorph mode, through lies, theft, dissimulation, tears and depression. This will go on for hours, with incessant masturbation, encopresis, daytime enuresis, and abrupt changes of attitude, like requests for hugs followed by unpredictably hitting the face of her foster mother, who is disappointed and overwhelmed.

Although the grandfather who abused Sabine is in jail, this little girl, who in fact is in no way psychotic, is not at all protected by the justice system from her father’s manipulative violence. We observe how she cannot get better as longer as she is obliged to meet with him.

Examples of actual moments of her life:

Each time the father comes to see his daughter in the Mediation Center designated by the judge, the perversion of the paternal function is reactivated. This father must have had a good teacher, as the son of "big Grampa Yuck", and the social worker recounts two recent attitudes of his which demonstrate this very well:

Once he is playing cards with Sabine. He starts off playing normally, them loudly asserts that now he will CHEAT. Between adults this may be just a joke, or a code between the regulars in a bar, but in this particular situation, for Sabine, it is mainly a reminder the arbitrary omnipotence of a father who acts only according to his own desire, making rules however he feels like it. The immediate result observed by those present: Sabine stops playing.

When he comes to see his daughter he always brings lollipops, a woman educator tells us. Hear we can detect for Sabine a new metaphorical reminder of the oral incestuous primal scene, which is a memory of the traumatic scene she went through, not a fantasy of a scene. The father offers a lollipop to the educator, who, aware of the father’s dubious little trick, refuses this equivocal offer. The father then says, "You’re afraid? But I’m not a pervert, after all." With this remark, the father shows himself to be a intrusive and provocative personality, dramatizing the disavowal that turns the disavowed accusation back onto the speaker, who finds herself accused of having unwholesome thoughts. By playing like this in front of Sabine, he shows his power to intimidate the educator.

Second post-incestous fantasy

After the series of carrots and beneath them, Sabine spontaneously and carefully draws a baby that she calls BABY YUCK.

She says that he is two years old – the approximate date of the rapes; with this precision Sabine dramatizes the imaginary risk of being impregnated by the mouth. This fantasy condenses her infantile sexual fantasy at the time and her desire when she was four years old, giving us access to the saturation of her Oedipal desires by the acted-incest and transfigured by the perversions of the abusive grandfather. Thus this reactional baby is well-named when he is called baby-YUCK. This strong formulation evokes what is most disgusting coming from the grandfather, both what is impossible to think and the fright at the passage to the act against her and her body.

During another session, we will witness a third post-incestuous fantasy, specifically within the transference and directed at me.

Sabine draws a fellow whose pant has a bulge, strongly suggestive of an enlargement of the male sex organ. She then puts the big marker she has been drawing with into her mouth, looking at me out of the corner of her eye, her head bowed with a big charming smile. She makes very suggestive back and forth movements, staring at me, half hidden behind the picture. When the therapist tells her that she "can stop now", that "as grandfather Yuck is no longer inside Sabine all the time, he can go back to prison." And Sabine stops.

Her erotic conditioning made her mimic fellatio in a transferential game directed at me, where she was partly identified with her aggressor in his most flagrantly perverse gestures, here temporarily disentangled by the speech of the other therapist, by the interpretation of her fragmentation:

The abuser acting in her has been named.

Her drives can now be sublimated because two defense mechanisms tied to the trauma have been removed: repression and the incorporation of the phallic object of the adult’s enjoyment, which is particularly toxic here.

Her own process of symbolization can restart after a period of post-traumatic fixation-regression, of which these perverse and phobic mood disorders were the trace.

In addition, beyond this classical understanding, such perverse-seductive behavior in a child who has been seriously abused needs first to be understood as self-sacrificing, for it replays in action with me and in the presence of other adults a transference of what she has passively undergone by force and blackmail. By thus offering her active erotic participation she dramatizes the repetition compulsions from which she cannot get free all by herself. This shows us to what extent she is at risk of spontaneously placing herself in danger. The first step of the psychoanalytical treatment is thus to defuse her act (her sexual transferential behaviors) from what she has experienced and psychically incorporated as something toxic, and thus to defragment this unconscious identification from her rapist grandfather.

This first stage of interpretation can only function if the child is protected in a concrete way from the various actings of her particularly sadistic family group (aggravated in her case by the mother’s complicity). This is why the work that is undertaken is medical, social and legal; the psychiatrist or the pediatrician or the psychoanalyst alone cannot manage this kind of pathology. Therefore, net therapy comes first and individual therapy with the child afterwards.

III. IDENTIFICATION WITH THE AGRESSOR

In every tragic case like that of Sabine that we have treated in therapy for several years, the child will first show himself to be dissociated (D.I.D.). This child will fragment himself psychically, sometimes modifying his version of what happened, transforming his perceptions, expressing two contradictory attitudes at the same time. In addition to a structural splitting of the subject, we are faced with the "atomization" of his Ego, its fragmentation. "The loss of confidence in his perceptions, (Ferenczi), and sequestration (letter to Freud May 31, 1931), are associated with all the avoiding behaviors characteristic of post-traumatic syndromes (PTSD). Phobias are a sure trace of this, the most flagrant clinical manifestation, of the reactional counter-cathexis that calls into question the person of the abuser. At four years of age, "Arpad the little cock man" is doing peepee in the henhouse when a cock attacks his penis with its beak (Ferenczi 1913). After a year of latency he presented manic behaviors and his language became a gallinaceous chatter, associated with phobic avoiding conduct and sadistic fantasies, as well as very grave ritualized conducts call "positive totemism" by Freud (Totem and Taboo).

At that time Ferenczi had the courage to write (letter to Freud, 25.12.1929) that some of his colleagues have a vision of the neuroses derived from an underestimation of the traumatic reality in the pathogenesis: " The critical view that gradually formed in me in the process was that psychoanalysis engages much too one-sidley in obsessional neurosis and character analysis, i.e. ego psychology, neglecting the organic-hysterical basis for analysis. The cause lies in the overestimation of fantasy, and the underestimation of traumatic reality in pathogenesis." Today it is even worse: among professionals in the relation to the child, we see an overvaluation bordering on a hypertrophy of fantasy and thus on a radical denaturation of the reality experienced by the child.

But in Freud’s work everything is in the proper place clinically, including in the "Outline of Psychoanalysis", his final work, a true testament dated 1939. At the end of his life, he revisits the precise notions about trauma, clearly calling them "attempted rapes", as he had earlier opposed hysteria, associated with "prepubescent sexual shock" and obsession, associated with "prepubescent sexual pleasure." ("Presexuallen-sexual-Schreck, Presexuallen-sexual Lust", letter to Fliess, October 15, 1895).

When Freud is careful to mention these children in the "Outline", he does not say that he is taking care of them, but that he does not forget them. He observes that the prognosis is disastrous: stunting of their growth, grave neurosis, mood disorders, psychopathies, perversions, and psychosis, to some extent the entire gamut of mental pathology that we find in children, adolescents and adults!

In "A Child is Being Beaten", Freud already clearly states in 1919 that "it is the doctor’s duty to speak out in favor of the rights of childhood".He adds that, "when we find a sexual aberration in the adult – perversion, fetishism, inversion – we have the right to expect to find through the anamnesis this sort of FIXATIVE EVENT in childhood."

To care for abused and humiliated children, it is first necessary to diagnose this fixative event and the post-traumatic pathology at the very moment when the situation presents itself. When the revelation made by the very young child borders on scandal, and the child’s explosive pathology threatens the entourage and himself, because of the perverse practices that he in turn will engage in, all of his pre-existing equilibrium is shattered (Zersplitterung, Ferenczi). In this we find again the psychical fragmentation (Fragmentierung, Ferenczi), that Freud comments on in 1930 (letter cited above).

IV. LOVING THE TRUTH?

It is necessary to know if a child’s revelations are true or false. This is the only position a citizen can take in the face of such a doubt.

To make a diagnosis when a judgment has not yet been pronounced, one must first rule out situations where the lying manipulations of one of the parents are apparent and require "prudence and circumspection", in order not to avoid the risk of ratifying one of the two versions of a marital conflict in crisis.

Sometimes a child lies by proxy, to protect himself, necessary lies (Ferenczi, letter to Freud, Aug. 3, 1926).

We also see pathological allegations made by an anxious mother accusing the father or another man in the family of behaving in a perverse way with their minor son or daughter, but this is only one element in the evaluation. In some cases I have encountered, the mother’s deception has rather quickly become apparent, either as real, conscious manipulation, or as an unconsciously maintained illusion, or as a blatant symptom of an interpretive pathology in the mother (delusion of influence or paranoia which may often be very pernicious).

Freud put the issue of lies into perspective when he pointed out, in the case of "Little Hans": "Children do not lie without reason either, and have, in general, more propensity for the love of truth than their elders."

In the case of Sabine, Baby-Yuck, the fantasmatic consequence of the real she has undergone, is symbolically confided to the therapists, so that it will remain on deposit at the Center. She can then free herself of it, thus ridding herself of a "teratoma, an interior twin"(Ferenczi’s formulation in "Principle of Relaxation and Neo-Catharsis"). She separates herself from a foreign body that is like a dead part of herself, like an incorporated "hostage", which comes to invade her psyche, and in her transference onto our theraputic proup she can entrust it to us, "so that he can be cared for," she tells us.

Her fantasy is no longer fixed, she no longer needs to sacrifice herself. In the coming weeks, she stops putting herself in physical danger of death with her acrobatics, and also stops attacking the boys in her entourage by opening their pants, which risked putting her in moral danger.

We have not yet managed to see Sabine’s mother, who does not reply to our requests for an interview, so we are not able to speak of her. Nevertheless, we know through the social workers that she shows no interest in her children’s moral well-being, preoccupied as she is by her chronic alcoholism. The diagnosis that could be made would pass by the possibility of gaining access to the existence of an incestuous preoccupation in the mother, inductive and not very available. It would be a matter of hysterical psychosis with exacerbated sensitive tendency, children in foster care, abused, mistreated, raped, psychopathic, drug-addicted, narcissistically very disturbed. Projective identification is usual means of control and fusion with the psyche of their children for many of these mothers, themselves former victims.

In his Clinical Journal of 10 April 1932, Ferenczi wrote: "This question is knowing if we shouldn’t look for the originary trauma every time in the originary relation with the mother, and if traumas from the period a little later, already complicated by the appearance of the father, could have such an effect without there being such a archi-orginary mother-child traumatic scar (Ur-Ur-traumatische-mutterlische-Kinderlische Narbe).

"una preessistente cicatrice traumatica pre-primaria madre-filio"

in English :

"A pre-primal-trauma mother-child scar."

Conclusion

What we most often observe is the under-valuation of traumatic reality by professionals. But also by the child himself, for a completely different reason, as a consequence of the confusion of roles induced in the child by the pathological behavior of the adults. These behaviors are characterized by parental deficiencies, especially maternal ones, by abuse of all kinds, with the addition of pedophiliac perversions.

From this emerges the attitudes of the abused child who seeks to minimize what has happened, by retracting what he has said, in other words, by accusing himself of being a liar. This is his "self-sacrifice of his integrity of thought," "the better to save" the idealized image of the parent in question (Ferenczi).

This clinical observation leads us to elaborate a therapeutic setting different from classical settings, to have a better care-giving attitude when faced with these psychical catastrophes in children whose prognoses are so grave.

When this dimension can be fully grasped, the treatment of identity disorders in the minor child, most often prepubescent, his dissociations, his introjected guilt, can begin to de-fragment. He can then gain access to an equilibrium unknown to him until now, and adapt himself to the world and its interior catastrophes, thanks to be able to symbolize them.

This net psychotherapy allows access to the "relation of the subject to the truth as cause" (Lacan), but of a nascent subject who must first be founded and recognized as a subject of rights.

What was refused to such a child by the act of incest is restored to him by the guarantee that this therapy gives him and that the justice system can offer him, giving him a chance to become, before it is too late, the subject of his desire.

SHORT BIBLIOGRAPHY

Ferenczi-Bateson, la double écoute, Cahiers critiques N°7