Sexual Abuse and its Consequences

I THINK THAT IN HIS paper "Confusion of tongues between adults and the child" Sándor Ferenczi perhaps overstressed the role of sexual abuse in childhood as a determinant of adult neurosis. By placing it first and discussing it most fully, he seems to suggest that it is a more common source of neurosis than, for example, neglect and cruelty—a claim that my patient sample, at least, will not bear out. I have certainly had patients who were sexually abused, however, and I believe it would be hard to improve on Ferenczi's insights into the psychological sequelae of such abuse, particularly the identification with the aggressor and the consquent self-hatred, together with "precocious maturity." As in so many of his writings, the great-hearted Ferenczi seems naturally intuitive; he feels the child's confusion from the inside, and this permits him to identify its dynamics.

There is another aspect of the problem, one that Ferenczi does not discuss in "Confusion of tongues" but of which he was surely aware, and that is that sexual abuse alone does not break the child. Otherwise, how would we account for those cases in which two siblings (or more), both abused, go on to entirely different destinies—one, perhaps, to severe vulnerability or actual breakdown, the other to a reasonably happy and productive life? Explaining such differences brings us up against as many variables—genes, gender, birth order, and so on—as we encounter, for example, in Anthony and Cohler's (1987) The Invulnerable Child. But it is my observation that the critical variable may be the child's experience of "normal" love from another person (i.e., not the abuser). This need not be a person as central as a parent—it may be a grandparent, for example, or an older sibling or a teacher—and it is not necessarily critical that this love be accompanied by wisdom and/or maturity. Even in a very imperfect state, real affection from an adult can possibly offset the consequences of abuse, as in the following