In spring 2020, I worked as a research assistant on the Sexual Harms and Medical Encounters research hub. I reached out to survivors’ organisations and also sought out unpublished or ‘grey’ literature produced by voluntary and community organisations over the years in relation to child sexual abuse. My aim was to collate a corpus of research based on first-hand accounts of survivors’ experiences with health professionals in the UK since the late 1960s. This blog describes the themes that emerged from my research.
Signs and clues ignored
One key theme that stood out was that the signs and clues of abuse that the child/survivor conveyed were often not picked up on or noticed by health professionals. Survivors emphasised the resounding lack of professional curiosity and lack of awareness of these signs. One survivor, now an adult, recalled:[1]
‘During my childhood in the 1970s nobody ever took me to one side and asked if I was alright, despite my poor behaviour, poor health and falling school grades. I was written off as delinquent.’
Survivors say that despite the signs being present that should have led professionals to ask pertinent questions, they failed to ask questions that would likely have facilitated (earlier) disclosures.[2] Furthermore, the burden was placed on the child/survivor to disclose rather than on professionals constructing safe spaces that would have enabled the survivor to speak when they needed to or felt ready.[3]
Impact of inappropriate responses
Survivors often spoke of encountering inappropriate responses from health professionals when they disclosed the abuse. Receiving a poor or inappropriate service was described as more damaging than merely the absence of a positive experience and can have devastating consequences. It can take years before a survivor may feel safe enough to seek support again, if ever.[4] Survivors also stated that inappropriate responses can ‘mirror’ the abuse itself, leaving the child or young person feeling silenced yet again: ‘when you are told to be quiet, medical professionals are saying the same thing as abusers do.’[5]
The consequences of an inappropriate response to disclosure can be severe, long-lasting and manifest in different ways including the survivor retracting their allegation. One young survivor, who was abused by her father who also facilitated abuse by other men when she was between the ages of seven and fourteen, highlighted her ordeal:[6]
The first time I told, I told my teacher, and then a social worker came and two police officers, and umm, they wanted me to talk about it, what happened. But they invited my mum and dad and sat them in the room with me. And then they asked me what happened, and so I denied it and said no, nothing’s happening, ‘cause I could just see my dad in the corner and thought oh my god.
Professional avoidance
Avoiding disclosures or even the topic of child sexual abuse is a further theme and is something I had witnessed first-hand as an advocate in services for children who have been sexually abused and exploited. While launching a new service for survivors in the lecture room of one London’s major teaching hospitals, I was ordered by a hospital staff member to take down the event poster which included ‘child sexual abuse’ in the title.
There are many reasons why professionals, such as this person, may want to avoid seeing/ hearing those words and disclosures from survivors may even trigger their own trauma. However, what is clear is that avoidance and lack of engagement by health professionals when such sensitive information is shared can have significant and devastating consequences on survivors. As one survivor described:[7]
I wasn’t believed when I was twelve. A psychiatrist just said ‘These things happen.’ I am sure if I had been believed then it wouldn’t have continued to haunt me throughout my life.
For health practitioners (or anyone for that matter), avoidance can amount to collusion and enable the abuse to continue as no protective remedies are initiated. One survivor stated:[8]
My doctor knew I was being abused – I told him when I was 10. It was awkward for him because he was friendly with my family. I had a urinary infection from it – he gave me antibiotics but didn’t do anything else it was the start of a history of these infections, with sometimes unbearable pain.
Feeling pathologised
A further theme that resonated throughout the reports was survivors’ experiences of being pathologised by health professionals, who were preoccupied with diagnoses and locating the problem within the survivor. Many survivors also described having to repeat their accounts to each new professional as they were referred from service to service for, often short-term, crisis intervention support with little or no understanding of the traumatic impact of child sexual abuse on the survivor.[9] Specifically, one survivor’s account emphasised the impact of professionals never fully exploring the trauma:[10]
In terms of the sexual abuse, I’ve had no support but I’ve had all sorts of medication, ‘therapy’, CBT etc. on and off over the last 35 years due to anxiety, depression, suicidality, OCD, living with fear… the abuse I suffered as a child has never been addressed.
Similarly, a report by Allnock and Miller in 2013 draws attention to the number of young people experiencing significant distress, self-harm and suicidal ideation and accessing mental health services and stated that ‘most describe adverse experiences with these professionals whom they believe failed to recognise the signs and instead, blamed the young person.’[11]
Looking forwards
To conclude. There were examples of great practice, where survivors felt heard and advocated for, particularly within voluntary therapeutic services which were often formed through survivor led initiatives. There were also calls in these reports from survivors for health professionals to take a more proactive approach in asking questions and facilitating safe spaces to enable disclosures and not placing the burden on children/survivors themselves.[12]. One example of this was the proactive approach taken by a Scottish GP in the mid 1980s who normalised asking his patients whether they had experienced abuse in childhood. This demonstrated his awareness and his readiness to listen to them. It helped to create a safe space for survivors to disclose when they felt ready and serves as a great example of a type of practice that could be embedded more widely.[13]
[1] N. Smith, C. Doragu, and F. Ellis, “Hear Me. Believe Me. Respect Me. A Survey of Adult Survivors of Child Sexual Abuse and Their Experiences of Support Services.,” (Suffolk: Survivors in Transition and University Campus of Suffolk, 2015), 16.
[2] E. Bond, F. Ellis, and J. McCusker, “I’ll be a survivor for the rest of my life: Adult survivors of child sexual abuse and their experiences of support services.,” (Suffolk: Survivors in Transition and University Campus of Suffolk, 2018),10.
[3] Debra Allnock and Pam Miller, “No one Noticed, No one Heard: A Study of Disclosure of Childhood Abuse, “(London: NSPCC, 2013)
[4] N. Smith et al, “Hear Me. Believe Me. Respect Me.”
[5] Sarah Nelson, “Surviving Well” (Unpublished [?]), (Scotland: Wellbeing Scotland, 2020), 26.
[6] Allnock and Miller, “No one Noticed, No one Heard,” 22.
[7] N. Smith et al, “Hear Me. Believe Me. Respect Me,”15.
[8] Nelson, “Surviving Well,”26.
[9] Bond et al, “I’ll be a survivor for the rest of my life,” 10.
[10] N. Smith et al, “Hear Me. Believe Me. Respect Me,” 31.
[11] Allnock and Miller, “No one Noticed, No one Heard,” 29.
[12] Allnock and Miller, “No one Noticed, No one Heard,” 55.
[13] Nelson, “Surviving Well,” 2.
*Opinions expressed by guest bloggers are their own and don’t necessarily represent the views of the SHaME Research Hub.