Citation: Gallo-Silver L, Anderson CM, Romo J. Best clinical practices for male adult survivors of childhood sexual abuse: “Do no harm.” Perm J 2014 Summer;18(3):82-7. DOI: http://dx.doi.org/10.7812/TPP/14-009.
The health care literature describes treatment challenges and recommended alterations in practice procedures for female survivors of childhood sexual abuse, a subtype of adverse childhood experiences. Currently, there are no concomitant recommendations for best clinical practices for male survivors of childhood sexual abuse or other adverse clinical experiences. Anecdotal information suggests ways physicians can address the needs of adult male survivors of childhood sexual abuse by changes in communication, locus of control, and consent/permission before and during physical examinations and procedures. The intent of this article is to act as a catalyst for improved patient care and more research focused on the identification and optimal responses to the needs of men with adverse childhood experiences in the health care setting.
Introduction
One in 6 men are survivors of childhood sexual abuse, according to the literature.1-3 The legal, mental health, and research definitions of childhood sexual abuse are not the same. This article uses the legal definitions of childhood sexual abuse that includes vaginal, anal, and oral penetration; child prostitution; participation in pornography; repeated and purposeful exposure to adult sexual acts including viewing pornography; and excessive adult nudity and gratuitous showing of genitals to children.4In the US, 1 in 71 men (1.4%) reports having been raped, with 27.8% of these men indicating their first experience of rape by age 10 years or younger.5
On the basis of 2010 US Census figures for the male population (n = 151,781,326), there could be more than 24 million male survivors of childhood sexual abuse in the US.6 The number of potentially affected men indicates a need to educate physicians on best clinical practices for this at-risk population. Extensive research indicates that a history of childhood sexual abuse can have a major, long-term negative impact on the survivor’s health, well-being, and life expectancy.7
Kaiser Permanente Medical Services and the Centers for Disease Control and Prevention in Atlanta, GA, sponsored the Adverse Childhood Experiences (ACEs) Study, which assessed a large population of adult survivors from among 17,337 health maintenance organization members receiving health care services. This study identified a sample of 2310 women and 1276 men who met the criteria for self-acknowledged physical childhood sexual abuse involving physical contact, and it used a multivariate logistic regression analysis to predict what would or would not occur to the men and women in the sample.7 In addition, the researchers found that the presence of 1 type of child abuse made the potential for other types of child abuse more likely. The accumulation of abuse resulted in extraordinary increases in the risk factors to attempt suicide compared with those without any child abuse experiences, and an increased risk of alcoholism and illicit drug use as well as marital and family problems. The study demonstrated that the psychological, social, and behavioral outcomes of ACEs were identical for men and women.
Multiple studies of ACEs indicate the interplay between mental health and medical health. The psychological impact of an ACE may result in behaviors that diminish the overall health, exacerbate stress-sensitive conditions, and diminish a person’s willingness to seek timely treatment for medical problems.8-10
Even though this research8-10 indicates that the extent and impact of trauma for female and male survivors of childhood sexual abuse are the same, there continues to be a gender gap in the health care literature that focuses on the care of the male survivor. The literature in breast cancer and in obstetrics and gynecology addresses the issues of providing health care services to a sexually abused female patient. Physicians in these specialties perform genital examinations and related invasive procedures. The recommendations for physicians in these studies indicate the need to slow down the examination process to enable more communication with the patient as well as asking the patient for permission to proceed with the examination.11-18Medical internists and urologists examine men in a manner proximate to a gynecologist’s examination of women. Yet, no recommendations exist to address the issue of childhood sexual abuse and its potential impact on adult male patients.
Health Issues Affecting Adult Survivors of Childhood Sexual Abuse
Health care clinicians have identified that childhood sexual abuse raises the risk of a number of medical conditions and illnesses sometimes labeled “diseases of trauma.”16 These health problems, studied in both sexes, include asthma, chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, migraines, and chronic pain, among others.8,15,16,19 Therefore, physicians in numerous specialties are likely to have patients with a history of sexual abuse.
Male survivors of all forms of severe childhood psychological, emotional, or physical abuse resist disclosure of physical and psychological symptoms.20 In addition, men are more reluctant to report sexual abuse than are female survivors.20,21 A contributing factor to nondisclosure may be that men knew the abuser before the abuse, as suggested by literature reporting that the child usually knows the abuser a priori.22 In these cases, the abuser is a parent, sibling, other family member, family friend, coach, teacher, clergy, or other familiar person.22 This increases feelings of shame and betrayal. Adherence to the guidelines we propose when interacting with male patients with histories of trauma can be a powerful tool for helping deliver more beneficial health care to all men.23
Triggers and Triggering
Research has shown that although only a small fraction of physicians routinely inquire about historical traumatic incidents, most patients report that they would actually favor such inquiries.24 Although it is beyond the scope of this article to address the complexity of posttraumatic stress disorder, four symptom groups are conceptualized: reexperiencing the trauma, avoiding situations that remind one of the trauma, alteration of thoughts and mood stability, and increased sensitivity to stimuli/increased reactivity to stimuli.25 For survivors of sexual abuse, feelings of powerlessness can be pivotal.26 The power differential between the physician and patient, added to the anxiety and fear a person may have about one’s medical condition and symptoms, can render the health care environment particularly stressful to a person who feels emotionally and physically vulnerable in most environments.27
Volunteers from two peer support organizations (MaleSurvivor and Males for Trauma Recovery) provided vignettes of their distressing experiences receiving health care services. The men in these vignettes found certain aspects of their medical care “triggering,” which is an aspect of the increased sensitivity to stimuli and increased reactivity to stimuli. A trigger is any sound, word, smell, sight, taste, physical or emotional feeling, and/or other stimulus that evokes some aspect of a previous trauma, in this case childhood sexual abuse.28 Because of the obvious intimate nature of medical care, any number of triggers exists, among them the request to undress, physical contact, and positioning the patient’s body.28 As the literature indicates and the following first four vignettes describe, male survivors’ issues of trust, expectation of betrayal, and negative associations to touch may result in the reactivation of the trauma with potentially harmful effects.7,10,20-22,26,27
Communication privacy management theory developed a way of understanding how people evaluate the amount and type of privacy they need or want in interpersonal relationships and the ramifications of decision making about disclosure.29 This theory suggests that when the patient discloses a history of sexual abuse to the physician, the patient may initially feel less comfortable with the physician. This then renders the physician’s response to the information as essential to establishing an optimal physician-patient relationship.30,31
Vignette 1
“With my last heart attack, I almost did not call 911 because I was so afraid they would insert an IV [intravenous catheter] into my groin. I had told my cardiologist of my problem. When I was on the table in the operating room with IV Valium [diazepam] and morphine, I still, somewhere deep in my brain, realized that there was a needle stuck in my groin [for heart catheterization and implanting a stent]. I started flailing about in a full-blown panic attack. The doctor called for a crash team and had people hold me down while they administered restraints and got an anesthetist to put me completely under.”
Vignette 2
“Reluctantly I agreed to go to a gastroenterologist for a colonoscopy recommended by my internist because of blood in my stool. I had conscious sedation for the procedure. I told the doctor that I am a survivor of incest. During the procedure, I woke up feeling the scope inside my body and someone holding the cheeks of my behind open. I called out to the doctor that I was awake. I heard him tell the anesthesiologist to give me more sedation. Once I was in recovery, I knew what had happened, but the doctor did not mention it and acted as if nothing happened. Just like my dad after he would rape me, it was not mentioned, as if it never happened.”
Vignette 3
“My internal medicine doctor referred me to a sleep study, and I knew it would bring up issues of my sexual abuse. The abuse frequently happened at night once my parents had fallen asleep. The thought of someone watching me sleep brought up a little apprehension, yet the thought of possibly dying in my sleep [because of obstructive sleep apnea] overrode my anxiety, at least in the beginning of this medical procedure. I was lying on the bed, when the nurse put the instrument that measures the breath through the nostrils, my understanding of the procedure and all the coping techniques I had went out the window. The instrument placed in my nostrils triggered my rape response. It was as if the perpetrator was there placing his hands over my mouth and nose all over again.
“When I left the facility [I was] holding back the tears the best I could for as far through the building as I could. I felt like vomiting, but nothing came out. I went home and just blanked out for a while, then fell asleep. The office never called my primary doctor to explain what happened.”
Vignette 4
“I went to a urologist due to prostate symptoms. I was not able to find a woman urologist that would see adult male patients. I told the urologist about the sexual abuse when I was a kid, but he seemed not to get it. He told me to “drop ’em” (meaning pull down my pants) when he wanted to examine me. When he did the digital rectal examination, I winced due to the discomfort, and he joked: “And I didn’t even buy you a nice dinner.”
In contrast to these four vignettes, the following two vignettes demonstrate more effective physician responses to a patient’s disclosure of a history of childhood sexual abuse.
Vignette 5
“I passed out in the street and cut my face up when I hit the pavement. I woke up in the emergency room, and I was very scared. The thorough examination included a rectal exam. I began to shiver; I guess I was nervous, and I refused the examination. The ER [emergency room] doctor explained that he needed to see if I was bleeding and if that was why I passed out. Crying, I told him that my brother forced me to have anal intercourse when I was a kid. He was really cool. He said it was my choice to be examined. He told me if I agreed I would feel some pressure but he would be very brief. So I agreed. After, he asked me if I was okay and if I wanted to talk to a social worker.”
Vignette 6
“I had trouble swallowing and I was losing lots of weight. My regular doctor told me I needed to have a ‘scope’ [endoscopic examination] and sent me to another doctor for it. The new doctor told me what the scope was all about, and I freaked. I told him no way is anything going in my mouth and down my throat. He asked me if I had this test before or some other similar examination that upset me. I thought a moment and I said what the hell. I told [him] when I was nine, my hockey coach would get me drunk on beer and then I had to [perform oral sex on him]. The doctor looked shocked and sad. He told me I really needed this scope and he understood why I was upset about it. I knew he was right so I agreed to do it. The day of the scope, the doctor was very kind to me. He talked to me a lot about the scope and what he would be doing while I was sedated.”
Communication privacy management theory indicates that disclosure of private information, such as a history of sexual abuse or other ACEs, relies on privacy rules.29 Privacy rules focus on the issue of under what conditions disclosure occurs, such as the pluses or minuses of sharing private information in a specific situation or context. The men in these vignettes decided to disclose, which then altered the relationship with the physician. We suggest that the decision to disclose by a male survivor of childhood sexual abuse relates to the “triggering” discomfort/distress caused by the increased sensitivity/reactivity to stimuli. The success of the changed relationship requires an empathic physician response that recognizes the importance of the shared information for the patient and the patient’s distress.30-32 The physicians in Vignettes 1 through 4 responded without empathy. The resulting physician-patient relationship was unsuccessful in that the patients reported a negative experience. The physicians in Vignettes 5 and 6 responded empathically. The resulting physician-patient relationship was successful in that the patients reported a positive experience.
These six vignettes are neither representative nor an objective sample. Therefore, one cannot generalize from anecdotal information nor prove a cause-effect relationship. Yet, if physicians ignore, minimize, or deny the psychological debris of childhood sexual abuse for male survivors, they can inadvertently reinforce a survivor’s unwillingness to seek appropriate help, comfort, or support. In this way, medical care risks being a reenactment of the sexual abuse that was characterized by similar abuses of power. The physicians who recognized their patients’ distress and responded in empathic ways did not reinforce or reenact the patients’ abuse experiences.
Recommendations
We have identified ten recommendations for best clinical practice in providing health care to male survivors of childhood sexual abuse (see Sidebar: Recommendations for Best Clinical Practices with Male Survivors of Childhood Sexual Abuse and Adverse Childhood Experiences). These recommendations cluster around issues of communication, control, and permission. The communications cluster focuses on asking about the man’s sexual abuse history and, if one is present, the interpersonal aspects of processing the information as part of physician-patient relationship building.21 Part of the control cluster focuses on integrating the process of anticipation of potentially triggering aspects of a medical examination, tests, and treatments. The permission cluster focuses on the interpersonal interchange that needs to take place before intrusive and intimate aspects of medical care begin. The gradual progression of a physical examination, which includes talking the patient through the process, is a way of pacing the examination at the speed the patient is most comfortable.
Communication between physician and patient is a crucial foundation of good medical care and cannot be limited to the physician asking questions of the patient and recording the answers. The typical busy medical practice poses a challenge to optimal communication. In addition, the electronic medical record can make it easy for a physician to gaze at the computer screen or the keyboard rather than actually face and interact with the patient. Most important is the physician understanding how to respond to the disclosure of a history of childhood sexual abuse empathically.33 The physician’s empathic response enhances the relationship with the patient who has taken the risk of disclosure.31 This requires eye contact, not introducing another question, and not changing the subject but presenting concern and a willingness to learn more if the patient wants to continue to share (see Sidebar: Empathic Communication Techniques with Men Disclosing Histories of Childhood Sexual Abuse and Adverse Childhood Experiences). Asking a follow-up question is not an empathic response to disclosure; rather, it prevents the patient from sharing important information of how to proceed with his care. Following an empathic response to the disclosure of child sexual abuse, it tends to comfort the patient to ask how his experience of childhood sexual abuse affects him now.
The locus of control in the health care of the male survivor needs to be with him and not the physician. It is common, even in this era of consumer-oriented medicine, for a patient to be overwhelmed or intimidated during interaction with physicians. For some patients, physicians are an authority figure, and it is important for physicians to keep in mind that the abuser was often an authority figure as well. Consent is a moment in time, yet a male survivor is the type of patient who might believe that once he has agreed to a procedure or treatment, there is no other recourse but to acquiesce even if he has changed his mind. Pacing is a way of approaching things in a gradual rather than in a propulsive manner. A physician may proceed with an examination from body part to body part or organ system to organ system in a routine familiar and typical for the physician but unusual and extraordinary for the patient. Physicians need to continue to take a “sounding” from their male survivor patient to maintain an ongoing dialogue about the patient’s comfort with the decisions he has made. A “sounding” is a clear, concrete request for information about a patient’s experience and coping ability in the moment.
Permission is perhaps the most important aspect of the physician-patient relationship. We recommend that physicians specifically ask for permission. For particularly invasive procedures (eg, digital rectal examinations, testes examinations, retraction of the foreskin of the penis), it is best to specifically engage the patient in a “sounding” on how the patient is coping in the moment. As indicated by the first four vignettes and the introductory case material, the male survivors were not able to articulate their distress as it related to their abuse. A physician may believe that
s/he has the patient’s permission to examine him simply because the patient is in the examination room and complying with the physician’s requests. Even if physicians inform a patient of what they will do during an examination or procedure, in the context of the physician as the authority, it implies the patient has no choice. This can easily replicate the patient’s history of sexual abuse, in which his body ceases to be his own and the abuser uses his body in various ways.
Conclusions
Childhood sexual abuse affects a substantial number of men, making it imperative that physicians engaged in male health issues alter their practice to meet their patients’ needs. Childhood sexual abuse has adverse long-term effects on the physical and mental health of survivors. In particular, childhood sexual abuse disrupts interpersonal relationships and can manifest itself in mistrust, fear, avoidance, and suspiciousness of authority figures in their lives. Best clinical practices with male survivors of childhood sexual abuse include physicians considering changes in the way they initially identify this patient population, communicate, respond, listen to, involve, examine, and plan for effective and empowering interactions with them. The male survivor population as a health care consumer group requires rigorous scientific research similar to the research that exists on women survivors. This could ultimately improve the medical care of male survivors.
Disclosure Statement
The author has no conflicts of interest to disclose.
Acknowledgment
Kathleen Louden, ELS, of Louden Health Communications provided editorial assistance.
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http://sol-reform.com/News/wp-content/uploads/2016/04/Hamilton-Logo.jpg00SOL Reformhttp://sol-reform.com/News/wp-content/uploads/2016/04/Hamilton-Logo.jpgSOL Reform2014-08-03 21:59:512014-08-03 21:59:51Gallo-Silver L, Anderson CM, Romo J. Best clinical practices for male adult survivors of childhood sexual abuse: “Do no harm.” Perm J 2014 Summer;18(3):82-7
A 67-year-old Epsom man is accused of abusing multiple children in incidents dating to 1991, and the police said an additional case could be pending in Maine.
Belknap County officials arrested Kenneth Day at his home yesterday afternoon on four charges and 300 counts of aggravated felonious sexual assault involving two people who were children at the time of the incidents, officials said.
Yesterday, officials heard that three more people might also have been abused, but Barnstead police Sgt. Joseph McDowell, who assisted with Day’s arrest, said those reports have not yet been confirmed.
In the case connected to yesterday’s arrest, a man and a woman told the police that Day sexually abused them in a school bus that had been converted into a camper located in Barnstead, McDowell said. He was unable to give the exact location of the camper and said he was not sure whether Day had been using it as a home.
Another person reported having been abused by Day in Barnstead and in Maine, McDowell said, but that case is going to be pursued in Maine because the statute of limitations has expired in New Hampshire. McDowell could not say when that person said the abuse took place.
In New Hampshire, someone who was sexually abused as a child has until they are 40 years old to press criminal charges, according to state law. Maine has no criminal statute of limitations for child sexual abuse if the person was younger than 16 at the time of the abuse, according to its state law.
McDowell could not specify the exact time frame for the abuse in any of the cases, but said the incidents occurred when the individuals were “preteens.”
The police began investigating Day several months ago, McDowell said, after two of the people involved came forward separately to report they were abused. The two knew each other outside of the case and knew Day before the alleged abuse, McDowell said.
The Belknap County Sheriff’s Department made the arrest with assistance from the Epsom Police Department, the Barnstead Police Department and other agencies, McDowell said. At this time, McDowell said he is unaware whether federal authorities may become involved in the case.
The police have also made the New Hampshire Division for Children, Youth & Families aware of the case, McDowell said. The agency’s director, Maggie Bishop, said reports are confidential and she could not confirm additional details.
Bishop said a person might delay reporting his or her abuse for several reasons – they might be afraid no one will believe them, she said, or they might fear retaliation for accusing someone of abuse.
“Every victim deals with the trauma of sexual abuse differently,” Bishop said, adding that she’s witnessed a range of responses to abuse in her decades of work with the division.
In recent years, Bishop said, society as a whole has also become more vigilant about educating children about abuse and encouraging survivors to come forward.
“Especially to children, more often than not, it is someone they know or someone they trust,” Bishop said. “It’s usually people they expect to protect them.”
As of last night, Day was at the Belknap County jail and had refused bail. He will be arraigned at 10 a.m. today via video, a corrections official said. Day was not previously listed as a registered sex offender, and McDowell said he was unaware of the man’s past criminal history.
The Barnstead police are asking anyone with additional information to contact the department at 269-4281 or Belknap County Sheriff’s Office Detective Judy Estes at 527-5454.
(Casey McDermott can be reached at 369-3306 or cmcdermott@cmonitor.com or on Twitter @caseymcdermott.)
But given the Catholic Church’s recalcitrant moves toward transparency and reform regarding priest sex abuse, it’s easy to be skeptical about Pope Francis’ latest apologies to victims and his pledge to hold bishops accountable for the priests in their charge.
In the Albany Diocese that includes our area, 300,000 Catholics are waiting to see if he’s sincere or if he’s just like his predecessor who paid lip service to the problem in hopes that it would fade away.
This is not just a Catholic problem or a religion problem. It’s society’s problem. And we should all be watchful of how the church responds to this latest initiative from Rome.
Unfortunately, despite it all but disappearing from the headlines in the last few years, sex abuse by priests is still a problem that the church, and the Albany Diocese’s new bishop, Edward Scharfenberger, need to address.
Just in April, James Michael Taylor, a local priest who served in Niskayuna and Clifton Park, was charged by police in Saratoga County with having inappropriate sexual contact with a 15-year-old girl at the Corpus Christi Parish.
In that case, the bishop acted quickly in removing Taylor from the parish and vowed to cooperate with police in the investigation. That was a positive sign.
At least 20 priests from within the Albany diocese were removed after credible accusations of abuse were made against them under the former bishop, Howard Hubbard. And the diocese was not immune to allegations that it moved priests to other parishes to hide them and to cover up allegations.
We don’t know how much sex abuse by its priests that the church is still covering up, how many unreported cases are lingering from the past, and whether abuses are still going on that haven’t yet been disclosed.
What we do know is that the bishops have a new directive from the new pope to be more aggressive and proactive in rooting out abuses and bringing them to authorities.
“There is no place in the Church’s ministry for those who commit these abuses,” the pope said after meeting with six church sex abuse victims last week. “I commit myself not to tolerate harm done to a minor by any individual, whether a cleric or not.”
One victim of abuse from Ireland said Pope Francis’ meeting with victims and his chastising of bishops was nothing more than a public relations stunt designed to make people think the church was finally getting serious about the abuses.
The international community also has not been convinced of the Catholic Church’s sincerity to solve this problem.
In May, more than a year into Pope Francis’ tenure, a United Nations panel ripped the Holy See for failing to take adequate measures to address the child-abuse situation and issued eight pages of recommendations for how it should move forward.
New York state can certainly do more to help the bishops with their new directive. We recently editorialized (Sunday June 29, 2014 “New York Needs Longer Statutes of Limitations on Child Sex Crimes”) in favor of the Child Victims Act, legislation that would extend the statute of limitations on child sex crimes and open a one-year window for older cases. New York has among the shortest time frames in the country for bringing charges in child sex abuse cases.
The state has in recent years increased penalties for abusers and in 2012 extended the “look-back time” that authorities can apply to old convictions in order to boost the criminal charges for newer allegations.
But New York also should continue to move forward in ways similar to the Office of Court Administration’s Human Trafficking initiative, which is designed to make New York courts more efficient and conducive to helping victims.
The church has a lot at stake by doing more to curb sex abuse. Since 1950, it has paid out about $2.5 billion to abuse victims in the U.S. alone, according to a Vatican spokesman. If the church recognizes more victims and ferrets out more , expense could skyrocket. Money is not the only reason to cover up abuses, but it’s a big one. Still, for an organization that by a 2012 estimation by The Economist spends $170 billion a year and has an untold net worth, even many more successful lawsuits wouldn’t break the Vatican bank.
A tangible, proactive movement could help restore faith in the church by its own membership , which has fallen precipitously in the last four decades. The sex abuse scandals share a lot of the blame for that drop-off.
We hope Pope Francis sincere and that Bishop Scharfenberger takes this directive heart. For them to be anything less than 100 percent commit ted to resolving this problem would be – using Pope Francis’ own word to describe scandal – “despicable.”
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When Pope Francis met earlier this month with victims of rape and sexual abuse by priests, he vowed to hold bishops accountable for covering up the scandal instead of confronting it.
A good place to start is with the St. Paul-Minneapolis archdiocese, where calls are mounting for the resignation of Archbishop John Nienstedt, a warrior against same-sex marriage who, it turns out, is facing accusations that he indulged in improper sexual conduct in the past with priests, seminarians and other men.
The archbishop has denied the accusations as “entirely false,” saying they date back over 10 years and do not involve minors or criminal conduct. But he felt obliged to hire a law firm to investigate them.
Meanwhile, his handling of the pedophilia scandal is under fire from all sides. This week, an affidavit from Jennifer Haselberger, the former canon law chancellor for the archdiocese, accused the archbishop and his ranking prelates of systematically ignoring warnings about abusers in a five-year period, while failing to inform civil authorities of possible criminal acts.
In the affidavit made public Tuesday, Ms. Haselberger, who resigned last year, said every time she tried to warn the archbishop and his deputies about abusive priests who were still serving in parishes, her “concerns were ignored, dismissed, or the emphasis was shifted to what was best for the priest involved.”
Ms. Haselberger wrote that she “abandoned hope that this situation could be resolved by the present administration,” in her rebuttal to the claims of the archdiocese that it had met its responsibility to protect children from rogue priests.
Archbishop Nienstedt acknowledged earlier this year in a sworn deposition for a pedophilia lawsuit that he did not fully disclose to police or parishioners which priests were under suspicion. But the archdiocese insists reforms have since strengthened disclosure.
The situation was only worsened by another deposition from a former vicar general of the archdiocese, the Rev. Peter Laird, who in conferences last year with Archbishop Nienstedt twice suggested that the archbishop consider resigning. Concerned Catholic parishioners, individual clergy members and university professors have also called for the archbishop to resign as the best solution. Instead, the archdiocese has made a mockery of accountability.
Hundreds of American priests have been forced from service because of pedophile crimes, but the parallel need for accountability among those who covered up the scandal has been shamefully avoided. In promising closer attention to this issue, the pope should not overlook the church’s leadership disarray in the Twin Cities.
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VATICAN CITY – More than a meeting and homily, Pope Francis laid out a clear road map for the church when he celebrated Mass and welcomed abuse survivors to the Vatican.
The morning he dedicated to six men and women who had been abused by clergy was a powerful combination of upholding the importance of having the letter of the law and displaying the proper spirit behind it.
Jesuit Father Hans Zollner, a German psychologist and psychotherapist who accompanied the two abuse survivors from Germany July 7, said: “This is not only about the letter of the law. This has to come from the heart if this is to really take fruit” and make real, lasting change.
The homily-plan of action repeated calls for zero tolerance and accountability for the “despicable” crime of abuse and underlined continued commitment to vigilance in priestly formation and better policies, procedures and training for the implementation norms.
But most striking that day, some of the visiting survivors said, were not the pronouncements at Mass, but the heart that went into the patient, one-on-one listening later, in private.
While Pope Benedict XVI began the highly symbolic meetings with groups of survivors with his 2008 visit to Washington D.C., Pope Francis took the practice further.
He invited survivors to the heart of the church in Rome for a real sit-down conversation – devoid of aides and officials, for a total of two and a half hours.
“The pope gave so much time. There was no hurry, there was no clock watching. Each survivor got the time they needed to tell the pope their story or whatever they wanted to say,” said Marie Collins, who accompanied one of the two survivors from Ireland for the closed-door papal meeting.
“It was wonderful to see the pope listening so intently, for the survivor to feel heard and have the opportunity to say everything they wanted to say,” said Collins, who is also a survivor of clerical abuse.
The eye contact, the silent reflection and how the pope reacted all showed how “it must have been hugely emotional for him as well as for each of the survivors,” she said.
This seemingly simple feature of limited distractions and formalities ended up being an unexpected turning point for many of the visitors, Collins said, even “life-changing” for another who later spoke to the press.
Collins and Father Zollner, both members of the new Pontifical Commission for the Protection of Minors, said listening not just to groups but to the personal stories of individual survivors is a message to all bishops of what they should be doing in their own countries.
“Now every victim in the world can say, ‘Look, you have to do what the pope did,’” Father Zollner said.
Collins said: “It’s a win-win situation. For the survivors it can be very healing to be listened to” and when church leaders hear and learn more about the nature and effects of the abuse, “it can help them” in seeing what should be done.
But because what can be done and how to go about it are not always clear, dozens of church leaders meet every year for the Anglophone Conference on the Safeguarding of Children, Young People and Vulnerable Adults.
Founded in 1996, the annual conference brings together experts and church delegates from around the globe, to share best practices and develop solid norms in the prevention and handling of the scandal of sexual abuse.
Collins and Father Zollner were among the speakers at the July 7-11 conference, which was being held in Rome the same week the pope met with victims.
Deacon Bernard Nojadera, executive director of the U.S. bishops’ Secretariat of Child and Youth Protection, said the Anglophone conference “is like a think tank” where people can bounce ideas around and have a healthy dialogue.
There can never be a “cookie-cutter approach,” said Francesco Cesareo, chairman of the U.S. National Review Board, because different cultures have different attitudes about how to talk about sexuality.
But, he said, common sense patterns emerge and, with input from the Vatican’s Congregation for the Doctrine of the Faith, which deals with sex abuse cases, the conference “brings a realistic sense of what can be done.”
Bishop R. Daniel Conlon of Joliet, Ill., chairman of the U.S. bishops’ Committee on the Protection of Children and Young People, said in one sense, responding to the abuse crisis should seem very simple. After all, “it is shepherding and a caring for the flock, but the milk is out of the bottle,” he said, adding, “Humpty Dumpty is broke.”
No matter what gets done for victims or perpetrators, “it won’t repair the damage,” he said.
Cesareo said that’s why so much talk must look at the future.
“How will the church prevent the same level of abuse? We should be prepared for the future and that’s more difficult,” he said.
“This is just planting the seeds,” Deacon Nojadera added.
Problems will still exist and some forms of abuse will happen, he said, but the church must have “a culture that’s reliable,” where everyone knows what warning signs to look for and where to get help.
In the church’s decades-long evolution of grappling with the reality of abuse within its own walls, Father Zollner said laws won’t matter unless there is “a whole change of culture within the church,” one that is no longer “drawn to secrecy,” cover-ups and siding with the perpetrator, but to openness to the truth and listening to victims.
Helping church leaders listen to survivors is key to getting leaders to see the importance of norms and enforcing them, he said.
Hearing their stories “changes your life and your attitude toward the whole issue,” he said, “if your heart is not made of stone.”
A heart hardened to human suffering and misery is one of the worst things that can happen, the pope has said, and that’s perhaps why, in his homily for victims, he prayed “for the grace to weep, the grace for the church to weep and make reparation.”
Along with reparation, therapy and support, Father Zollner said, “There is nothing that is more important than an open ear and an open heart, because this is the way reconciliation can start.”
From July 18, 2014 issue of Catholic San Francisco.
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LUDLOW – A new bill has been signed into law by Gov. Deval Patrick that extends the statute of limitations for sex abuse victims to file suit against their abusers.
The new law allows any childhood sex abuse victim up to the age of 53 to file civil charges against their alleged abuser. Prior to the passage of the new law sex abuse victims only had until age 21 to file civil suits against their abusers.
The law was signed by Patrick after it was unanimously approved in the House and Senate.
Kathy Picard, 51, of Ludlow, who says she is the victim of childhood sexual abuse, says she worked for 12 years for passage of the bill. She said she now has filed suit against a male family member who abused her between the ages of 7 and 17.
Victims of childhood sexual abuse should have the right to seek justice, Picard said. She said there is no statute of limitation for charging that someone committed murder.
“Childhood sexual abuse is the murder of a person’s innocence,” she said.
Picard said she told family members about her own childhood sexual abuse which took place between the ages of 7 and 17 and was advised to keep quiet about it.
Picard said she has worked to change the statute of limitations for 12 years.
In 2006, the criminal statute of limitations pertaining to childhood sexual abuse was extended from 15 years after the 16th birthday to 27 years.
“That happened when all the priest abuse (accusations) came out, and I thought, it’s not just priest abuse,” said Picard.
“This new law increases the statue of limitations to 35 years after a victim of sexual abuse’s 18th birthday to file a civil suit against their abuser,” Picard said. “The prior law gave victims only until their 21st birthday to file suit. Giving more survivors until the age of 53 will open doors for many.”
Picard plans to celebrate the new law with a reception on Aug. 23 at Samuel’s Sports Bar at the Basketball Hall of Fame in Springfield. Tickets are $25 per person. Picard said she is trying to raise money to support the curriculum she teachers at the YMCA of Greater Springfield. Picard teaches children how to recognize and report sexual abuse through the Child Help, Speak Up, Be Safe program.
Picard said one in four girls and one in six boys are victims of childhood sexual abuse.
For more information or if you would like to attend, email Kathy Picard at kathychildadvocate@gmail.com
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Gallo-Silver L, Anderson CM, Romo J. Best clinical practices for male adult survivors of childhood sexual abuse: “Do no harm.” Perm J 2014 Summer;18(3):82-7
/in Resources, Treatment /by SOL ReformCitation: Gallo-Silver L, Anderson CM, Romo J. Best clinical practices for male adult survivors of childhood sexual abuse: “Do no harm.” Perm J 2014 Summer;18(3):82-7. DOI: http://dx.doi.org/10.7812/TPP/14-009.
View PDF: http://www.thepermanentejournal.org/files/Summer2014/SexualAbuse.pdf
Abstract
The health care literature describes treatment challenges and recommended alterations in practice procedures for female survivors of childhood sexual abuse, a subtype of adverse childhood experiences. Currently, there are no concomitant recommendations for best clinical practices for male survivors of childhood sexual abuse or other adverse clinical experiences. Anecdotal information suggests ways physicians can address the needs of adult male survivors of childhood sexual abuse by changes in communication, locus of control, and consent/permission before and during physical examinations and procedures. The intent of this article is to act as a catalyst for improved patient care and more research focused on the identification and optimal responses to the needs of men with adverse childhood experiences in the health care setting.
Introduction
One in 6 men are survivors of childhood sexual abuse, according to the literature.1-3 The legal, mental health, and research definitions of childhood sexual abuse are not the same. This article uses the legal definitions of childhood sexual abuse that includes vaginal, anal, and oral penetration; child prostitution; participation in pornography; repeated and purposeful exposure to adult sexual acts including viewing pornography; and excessive adult nudity and gratuitous showing of genitals to children.4In the US, 1 in 71 men (1.4%) reports having been raped, with 27.8% of these men indicating their first experience of rape by age 10 years or younger.5
On the basis of 2010 US Census figures for the male population (n = 151,781,326), there could be more than 24 million male survivors of childhood sexual abuse in the US.6 The number of potentially affected men indicates a need to educate physicians on best clinical practices for this at-risk population. Extensive research indicates that a history of childhood sexual abuse can have a major, long-term negative impact on the survivor’s health, well-being, and life expectancy.7
Kaiser Permanente Medical Services and the Centers for Disease Control and Prevention in Atlanta, GA, sponsored the Adverse Childhood Experiences (ACEs) Study, which assessed a large population of adult survivors from among 17,337 health maintenance organization members receiving health care services. This study identified a sample of 2310 women and 1276 men who met the criteria for self-acknowledged physical childhood sexual abuse involving physical contact, and it used a multivariate logistic regression analysis to predict what would or would not occur to the men and women in the sample.7 In addition, the researchers found that the presence of 1 type of child abuse made the potential for other types of child abuse more likely. The accumulation of abuse resulted in extraordinary increases in the risk factors to attempt suicide compared with those without any child abuse experiences, and an increased risk of alcoholism and illicit drug use as well as marital and family problems. The study demonstrated that the psychological, social, and behavioral outcomes of ACEs were identical for men and women.
Multiple studies of ACEs indicate the interplay between mental health and medical health. The psychological impact of an ACE may result in behaviors that diminish the overall health, exacerbate stress-sensitive conditions, and diminish a person’s willingness to seek timely treatment for medical problems.8-10
Even though this research8-10 indicates that the extent and impact of trauma for female and male survivors of childhood sexual abuse are the same, there continues to be a gender gap in the health care literature that focuses on the care of the male survivor. The literature in breast cancer and in obstetrics and gynecology addresses the issues of providing health care services to a sexually abused female patient. Physicians in these specialties perform genital examinations and related invasive procedures. The recommendations for physicians in these studies indicate the need to slow down the examination process to enable more communication with the patient as well as asking the patient for permission to proceed with the examination.11-18Medical internists and urologists examine men in a manner proximate to a gynecologist’s examination of women. Yet, no recommendations exist to address the issue of childhood sexual abuse and its potential impact on adult male patients.
Health Issues Affecting Adult Survivors of Childhood Sexual Abuse
Health care clinicians have identified that childhood sexual abuse raises the risk of a number of medical conditions and illnesses sometimes labeled “diseases of trauma.”16 These health problems, studied in both sexes, include asthma, chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, migraines, and chronic pain, among others.8,15,16,19 Therefore, physicians in numerous specialties are likely to have patients with a history of sexual abuse.
Male survivors of all forms of severe childhood psychological, emotional, or physical abuse resist disclosure of physical and psychological symptoms.20 In addition, men are more reluctant to report sexual abuse than are female survivors.20,21 A contributing factor to nondisclosure may be that men knew the abuser before the abuse, as suggested by literature reporting that the child usually knows the abuser a priori.22 In these cases, the abuser is a parent, sibling, other family member, family friend, coach, teacher, clergy, or other familiar person.22 This increases feelings of shame and betrayal. Adherence to the guidelines we propose when interacting with male patients with histories of trauma can be a powerful tool for helping deliver more beneficial health care to all men.23
Triggers and Triggering
Research has shown that although only a small fraction of physicians routinely inquire about historical traumatic incidents, most patients report that they would actually favor such inquiries.24 Although it is beyond the scope of this article to address the complexity of posttraumatic stress disorder, four symptom groups are conceptualized: reexperiencing the trauma, avoiding situations that remind one of the trauma, alteration of thoughts and mood stability, and increased sensitivity to stimuli/increased reactivity to stimuli.25 For survivors of sexual abuse, feelings of powerlessness can be pivotal.26 The power differential between the physician and patient, added to the anxiety and fear a person may have about one’s medical condition and symptoms, can render the health care environment particularly stressful to a person who feels emotionally and physically vulnerable in most environments.27
Volunteers from two peer support organizations (MaleSurvivor and Males for Trauma Recovery) provided vignettes of their distressing experiences receiving health care services. The men in these vignettes found certain aspects of their medical care “triggering,” which is an aspect of the increased sensitivity to stimuli and increased reactivity to stimuli. A trigger is any sound, word, smell, sight, taste, physical or emotional feeling, and/or other stimulus that evokes some aspect of a previous trauma, in this case childhood sexual abuse.28 Because of the obvious intimate nature of medical care, any number of triggers exists, among them the request to undress, physical contact, and positioning the patient’s body.28 As the literature indicates and the following first four vignettes describe, male survivors’ issues of trust, expectation of betrayal, and negative associations to touch may result in the reactivation of the trauma with potentially harmful effects.7,10,20-22,26,27
Communication privacy management theory developed a way of understanding how people evaluate the amount and type of privacy they need or want in interpersonal relationships and the ramifications of decision making about disclosure.29 This theory suggests that when the patient discloses a history of sexual abuse to the physician, the patient may initially feel less comfortable with the physician. This then renders the physician’s response to the information as essential to establishing an optimal physician-patient relationship.30,31
Vignette 1
“With my last heart attack, I almost did not call 911 because I was so afraid they would insert an IV [intravenous catheter] into my groin. I had told my cardiologist of my problem. When I was on the table in the operating room with IV Valium [diazepam] and morphine, I still, somewhere deep in my brain, realized that there was a needle stuck in my groin [for heart catheterization and implanting a stent]. I started flailing about in a full-blown panic attack. The doctor called for a crash team and had people hold me down while they administered restraints and got an anesthetist to put me completely under.”
Vignette 2
“Reluctantly I agreed to go to a gastroenterologist for a colonoscopy recommended by my internist because of blood in my stool. I had conscious sedation for the procedure. I told the doctor that I am a survivor of incest. During the procedure, I woke up feeling the scope inside my body and someone holding the cheeks of my behind open. I called out to the doctor that I was awake. I heard him tell the anesthesiologist to give me more sedation. Once I was in recovery, I knew what had happened, but the doctor did not mention it and acted as if nothing happened. Just like my dad after he would rape me, it was not mentioned, as if it never happened.”
Vignette 3
“My internal medicine doctor referred me to a sleep study, and I knew it would bring up issues of my sexual abuse. The abuse frequently happened at night once my parents had fallen asleep. The thought of someone watching me sleep brought up a little apprehension, yet the thought of possibly dying in my sleep [because of obstructive sleep apnea] overrode my anxiety, at least in the beginning of this medical procedure. I was lying on the bed, when the nurse put the instrument that measures the breath through the nostrils, my understanding of the procedure and all the coping techniques I had went out the window. The instrument placed in my nostrils triggered my rape response. It was as if the perpetrator was there placing his hands over my mouth and nose all over again.
“When I left the facility [I was] holding back the tears the best I could for as far through the building as I could. I felt like vomiting, but nothing came out. I went home and just blanked out for a while, then fell asleep. The office never called my primary doctor to explain what happened.”
Vignette 4
“I went to a urologist due to prostate symptoms. I was not able to find a woman urologist that would see adult male patients. I told the urologist about the sexual abuse when I was a kid, but he seemed not to get it. He told me to “drop ’em” (meaning pull down my pants) when he wanted to examine me. When he did the digital rectal examination, I winced due to the discomfort, and he joked: “And I didn’t even buy you a nice dinner.”
In contrast to these four vignettes, the following two vignettes demonstrate more effective physician responses to a patient’s disclosure of a history of childhood sexual abuse.
Vignette 5
“I passed out in the street and cut my face up when I hit the pavement. I woke up in the emergency room, and I was very scared. The thorough examination included a rectal exam. I began to shiver; I guess I was nervous, and I refused the examination. The ER [emergency room] doctor explained that he needed to see if I was bleeding and if that was why I passed out. Crying, I told him that my brother forced me to have anal intercourse when I was a kid. He was really cool. He said it was my choice to be examined. He told me if I agreed I would feel some pressure but he would be very brief. So I agreed. After, he asked me if I was okay and if I wanted to talk to a social worker.”
Vignette 6
“I had trouble swallowing and I was losing lots of weight. My regular doctor told me I needed to have a ‘scope’ [endoscopic examination] and sent me to another doctor for it. The new doctor told me what the scope was all about, and I freaked. I told him no way is anything going in my mouth and down my throat. He asked me if I had this test before or some other similar examination that upset me. I thought a moment and I said what the hell. I told [him] when I was nine, my hockey coach would get me drunk on beer and then I had to [perform oral sex on him]. The doctor looked shocked and sad. He told me I really needed this scope and he understood why I was upset about it. I knew he was right so I agreed to do it. The day of the scope, the doctor was very kind to me. He talked to me a lot about the scope and what he would be doing while I was sedated.”
Communication privacy management theory indicates that disclosure of private information, such as a history of sexual abuse or other ACEs, relies on privacy rules.29 Privacy rules focus on the issue of under what conditions disclosure occurs, such as the pluses or minuses of sharing private information in a specific situation or context. The men in these vignettes decided to disclose, which then altered the relationship with the physician. We suggest that the decision to disclose by a male survivor of childhood sexual abuse relates to the “triggering” discomfort/distress caused by the increased sensitivity/reactivity to stimuli. The success of the changed relationship requires an empathic physician response that recognizes the importance of the shared information for the patient and the patient’s distress.30-32 The physicians in Vignettes 1 through 4 responded without empathy. The resulting physician-patient relationship was unsuccessful in that the patients reported a negative experience. The physicians in Vignettes 5 and 6 responded empathically. The resulting physician-patient relationship was successful in that the patients reported a positive experience.
These six vignettes are neither representative nor an objective sample. Therefore, one cannot generalize from anecdotal information nor prove a cause-effect relationship. Yet, if physicians ignore, minimize, or deny the psychological debris of childhood sexual abuse for male survivors, they can inadvertently reinforce a survivor’s unwillingness to seek appropriate help, comfort, or support. In this way, medical care risks being a reenactment of the sexual abuse that was characterized by similar abuses of power. The physicians who recognized their patients’ distress and responded in empathic ways did not reinforce or reenact the patients’ abuse experiences.
Recommendations
We have identified ten recommendations for best clinical practice in providing health care to male survivors of childhood sexual abuse (see Sidebar: Recommendations for Best Clinical Practices with Male Survivors of Childhood Sexual Abuse and Adverse Childhood Experiences). These recommendations cluster around issues of communication, control, and permission. The communications cluster focuses on asking about the man’s sexual abuse history and, if one is present, the interpersonal aspects of processing the information as part of physician-patient relationship building.21 Part of the control cluster focuses on integrating the process of anticipation of potentially triggering aspects of a medical examination, tests, and treatments. The permission cluster focuses on the interpersonal interchange that needs to take place before intrusive and intimate aspects of medical care begin. The gradual progression of a physical examination, which includes talking the patient through the process, is a way of pacing the examination at the speed the patient is most comfortable.
Communication between physician and patient is a crucial foundation of good medical care and cannot be limited to the physician asking questions of the patient and recording the answers. The typical busy medical practice poses a challenge to optimal communication. In addition, the electronic medical record can make it easy for a physician to gaze at the computer screen or the keyboard rather than actually face and interact with the patient. Most important is the physician understanding how to respond to the disclosure of a history of childhood sexual abuse empathically.33 The physician’s empathic response enhances the relationship with the patient who has taken the risk of disclosure.31 This requires eye contact, not introducing another question, and not changing the subject but presenting concern and a willingness to learn more if the patient wants to continue to share (see Sidebar: Empathic Communication Techniques with Men Disclosing Histories of Childhood Sexual Abuse and Adverse Childhood Experiences). Asking a follow-up question is not an empathic response to disclosure; rather, it prevents the patient from sharing important information of how to proceed with his care. Following an empathic response to the disclosure of child sexual abuse, it tends to comfort the patient to ask how his experience of childhood sexual abuse affects him now.
The locus of control in the health care of the male survivor needs to be with him and not the physician. It is common, even in this era of consumer-oriented medicine, for a patient to be overwhelmed or intimidated during interaction with physicians. For some patients, physicians are an authority figure, and it is important for physicians to keep in mind that the abuser was often an authority figure as well. Consent is a moment in time, yet a male survivor is the type of patient who might believe that once he has agreed to a procedure or treatment, there is no other recourse but to acquiesce even if he has changed his mind. Pacing is a way of approaching things in a gradual rather than in a propulsive manner. A physician may proceed with an examination from body part to body part or organ system to organ system in a routine familiar and typical for the physician but unusual and extraordinary for the patient. Physicians need to continue to take a “sounding” from their male survivor patient to maintain an ongoing dialogue about the patient’s comfort with the decisions he has made. A “sounding” is a clear, concrete request for information about a patient’s experience and coping ability in the moment.
Permission is perhaps the most important aspect of the physician-patient relationship. We recommend that physicians specifically ask for permission. For particularly invasive procedures (eg, digital rectal examinations, testes examinations, retraction of the foreskin of the penis), it is best to specifically engage the patient in a “sounding” on how the patient is coping in the moment. As indicated by the first four vignettes and the introductory case material, the male survivors were not able to articulate their distress as it related to their abuse. A physician may believe that
s/he has the patient’s permission to examine him simply because the patient is in the examination room and complying with the physician’s requests. Even if physicians inform a patient of what they will do during an examination or procedure, in the context of the physician as the authority, it implies the patient has no choice. This can easily replicate the patient’s history of sexual abuse, in which his body ceases to be his own and the abuser uses his body in various ways.
Conclusions
Childhood sexual abuse affects a substantial number of men, making it imperative that physicians engaged in male health issues alter their practice to meet their patients’ needs. Childhood sexual abuse has adverse long-term effects on the physical and mental health of survivors. In particular, childhood sexual abuse disrupts interpersonal relationships and can manifest itself in mistrust, fear, avoidance, and suspiciousness of authority figures in their lives. Best clinical practices with male survivors of childhood sexual abuse include physicians considering changes in the way they initially identify this patient population, communicate, respond, listen to, involve, examine, and plan for effective and empowering interactions with them. The male survivor population as a health care consumer group requires rigorous scientific research similar to the research that exists on women survivors. This could ultimately improve the medical care of male survivors.
Disclosure Statement
The author has no conflicts of interest to disclose.
Acknowledgment
Kathleen Louden, ELS, of Louden Health Communications provided editorial assistance.
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Police: Epsom man, 67, arrested on child sex abuse charges, Casey McDermott, Concord Monitor
/in Maine, New Hampshire, Uncategorized /by SOL ReformSource: http://www.concordmonitor.com/news/12793933-95/police-epsom-man-67-arrested-on-child-sex-abuse-charges
A 67-year-old Epsom man is accused of abusing multiple children in incidents dating to 1991, and the police said an additional case could be pending in Maine.
Belknap County officials arrested Kenneth Day at his home yesterday afternoon on four charges and 300 counts of aggravated felonious sexual assault involving two people who were children at the time of the incidents, officials said.
Yesterday, officials heard that three more people might also have been abused, but Barnstead police Sgt. Joseph McDowell, who assisted with Day’s arrest, said those reports have not yet been confirmed.
In the case connected to yesterday’s arrest, a man and a woman told the police that Day sexually abused them in a school bus that had been converted into a camper located in Barnstead, McDowell said. He was unable to give the exact location of the camper and said he was not sure whether Day had been using it as a home.
Another person reported having been abused by Day in Barnstead and in Maine, McDowell said, but that case is going to be pursued in Maine because the statute of limitations has expired in New Hampshire. McDowell could not say when that person said the abuse took place.
McDowell could not specify the exact time frame for the abuse in any of the cases, but said the incidents occurred when the individuals were “preteens.”
The police began investigating Day several months ago, McDowell said, after two of the people involved came forward separately to report they were abused. The two knew each other outside of the case and knew Day before the alleged abuse, McDowell said.
The Belknap County Sheriff’s Department made the arrest with assistance from the Epsom Police Department, the Barnstead Police Department and other agencies, McDowell said. At this time, McDowell said he is unaware whether federal authorities may become involved in the case.
The police have also made the New Hampshire Division for Children, Youth & Families aware of the case, McDowell said. The agency’s director, Maggie Bishop, said reports are confidential and she could not confirm additional details.
Bishop said a person might delay reporting his or her abuse for several reasons – they might be afraid no one will believe them, she said, or they might fear retaliation for accusing someone of abuse.
“Every victim deals with the trauma of sexual abuse differently,” Bishop said, adding that she’s witnessed a range of responses to abuse in her decades of work with the division.
In recent years, Bishop said, society as a whole has also become more vigilant about educating children about abuse and encouraging survivors to come forward.
“Especially to children, more often than not, it is someone they know or someone they trust,” Bishop said. “It’s usually people they expect to protect them.”
As of last night, Day was at the Belknap County jail and had refused bail. He will be arraigned at 10 a.m. today via video, a corrections official said. Day was not previously listed as a registered sex offender, and McDowell said he was unaware of the man’s past criminal history.
The Barnstead police are asking anyone with additional information to contact the department at 269-4281 or Belknap County Sheriff’s Office Detective Judy Estes at 527-5454.
(Casey McDermott can be reached at 369-3306 or cmcdermott@cmonitor.com or on Twitter @caseymcdermott.)
http://www.concordmonitor.com/news/12793933-95/police-epsom-man-67-arrested-on-child-sex-abuse-charges
Editorial: Pope, bishop must be sincere in rooting out sex abuse, Schenectady, The Daily Gazette
/in New York /by SOL ReformIt’s difficult not to take a pope at his word
But given the Catholic Church’s recalcitrant moves toward transparency and reform regarding priest sex abuse, it’s easy to be skeptical about Pope Francis’ latest apologies to victims and his pledge to hold bishops accountable for the priests in their charge.
In the Albany Diocese that includes our area, 300,000 Catholics are waiting to see if he’s sincere or if he’s just like his predecessor who paid lip service to the problem in hopes that it would fade away.
This is not just a Catholic problem or a religion problem. It’s society’s problem. And we should all be watchful of how the church responds to this latest initiative from Rome.
Unfortunately, despite it all but disappearing from the headlines in the last few years, sex abuse by priests is still a problem that the church, and the Albany Diocese’s new bishop, Edward Scharfenberger, need to address.
Just in April, James Michael Taylor, a local priest who served in Niskayuna and Clifton Park, was charged by police in Saratoga County with having inappropriate sexual contact with a 15-year-old girl at the Corpus Christi Parish.
In that case, the bishop acted quickly in removing Taylor from the parish and vowed to cooperate with police in the investigation. That was a positive sign.
At least 20 priests from within the Albany diocese were removed after credible accusations of abuse were made against them under the former bishop, Howard Hubbard. And the diocese was not immune to allegations that it moved priests to other parishes to hide them and to cover up allegations.
We don’t know how much sex abuse by its priests that the church is still covering up, how many unreported cases are lingering from the past, and whether abuses are still going on that haven’t yet been disclosed.
What we do know is that the bishops have a new directive from the new pope to be more aggressive and proactive in rooting out abuses and bringing them to authorities.
“There is no place in the Church’s ministry for those who commit these abuses,” the pope said after meeting with six church sex abuse victims last week. “I commit myself not to tolerate harm done to a minor by any individual, whether a cleric or not.”
One victim of abuse from Ireland said Pope Francis’ meeting with victims and his chastising of bishops was nothing more than a public relations stunt designed to make people think the church was finally getting serious about the abuses.
The international community also has not been convinced of the Catholic Church’s sincerity to solve this problem.
In May, more than a year into Pope Francis’ tenure, a United Nations panel ripped the Holy See for failing to take adequate measures to address the child-abuse situation and issued eight pages of recommendations for how it should move forward.
New York state can certainly do more to help the bishops with their new directive. We recently editorialized (Sunday June 29, 2014 “New York Needs Longer Statutes of Limitations on Child Sex Crimes”) in favor of the Child Victims Act, legislation that would extend the statute of limitations on child sex crimes and open a one-year window for older cases. New York has among the shortest time frames in the country for bringing charges in child sex abuse cases.
The state has in recent years increased penalties for abusers and in 2012 extended the “look-back time” that authorities can apply to old convictions in order to boost the criminal charges for newer allegations.
But New York also should continue to move forward in ways similar to the Office of Court Administration’s Human Trafficking initiative, which is designed to make New York courts more efficient and conducive to helping victims.
The church has a lot at stake by doing more to curb sex abuse. Since 1950, it has paid out about $2.5 billion to abuse victims in the U.S. alone, according to a Vatican spokesman. If the church recognizes more victims and ferrets out more , expense could skyrocket. Money is not the only reason to cover up abuses, but it’s a big one. Still, for an organization that by a 2012 estimation by The Economist spends $170 billion a year and has an untold net worth, even many more successful lawsuits wouldn’t break the Vatican bank.
A tangible, proactive movement could help restore faith in the church by its own membership , which has fallen precipitously in the last four decades. The sex abuse scandals share a lot of the blame for that drop-off.
We hope Pope Francis sincere and that Bishop Scharfenberger takes this directive heart. For them to be anything less than 100 percent commit ted to resolving this problem would be – using Pope Francis’ own word to describe scandal – “despicable.”
Holding Church Shepherds Accountable Pope Francis and the Bishops Who Hid Pedophile Priests, Editorial Board, New York Times
/in Uncategorized /by SOL ReformSource: http://www.nytimes.com/2014/07/18/opinion/pope-francis-and-the-bishops-who-hid-pedophile-priests.html?_r=2
When Pope Francis met earlier this month with victims of rape and sexual abuse by priests, he vowed to hold bishops accountable for covering up the scandal instead of confronting it.
A good place to start is with the St. Paul-Minneapolis archdiocese, where calls are mounting for the resignation of Archbishop John Nienstedt, a warrior against same-sex marriage who, it turns out, is facing accusations that he indulged in improper sexual conduct in the past with priests, seminarians and other men.
The archbishop has denied the accusations as “entirely false,” saying they date back over 10 years and do not involve minors or criminal conduct. But he felt obliged to hire a law firm to investigate them.
Meanwhile, his handling of the pedophilia scandal is under fire from all sides. This week, an affidavit from Jennifer Haselberger, the former canon law chancellor for the archdiocese, accused the archbishop and his ranking prelates of systematically ignoring warnings about abusers in a five-year period, while failing to inform civil authorities of possible criminal acts.
In the affidavit made public Tuesday, Ms. Haselberger, who resigned last year, said every time she tried to warn the archbishop and his deputies about abusive priests who were still serving in parishes, her “concerns were ignored, dismissed, or the emphasis was shifted to what was best for the priest involved.”
Ms. Haselberger wrote that she “abandoned hope that this situation could be resolved by the present administration,” in her rebuttal to the claims of the archdiocese that it had met its responsibility to protect children from rogue priests.
Archbishop Nienstedt acknowledged earlier this year in a sworn deposition for a pedophilia lawsuit that he did not fully disclose to police or parishioners which priests were under suspicion. But the archdiocese insists reforms have since strengthened disclosure.
The situation was only worsened by another deposition from a former vicar general of the archdiocese, the Rev. Peter Laird, who in conferences last year with Archbishop Nienstedt twice suggested that the archbishop consider resigning. Concerned Catholic parishioners, individual clergy members and university professors have also called for the archbishop to resign as the best solution. Instead, the archdiocese has made a mockery of accountability.
Hundreds of American priests have been forced from service because of pedophile crimes, but the parallel need for accountability among those who covered up the scandal has been shamefully avoided. In promising closer attention to this issue, the pope should not overlook the church’s leadership disarray in the Twin Cities.
Lead by example: Pope offers abuse victims open ear, open heart, Carol Glatz, Catholic San Francisco
/in Uncategorized /by SOL ReformJuly 15th, 2014
VATICAN CITY – More than a meeting and homily, Pope Francis laid out a clear road map for the church when he celebrated Mass and welcomed abuse survivors to the Vatican.
The morning he dedicated to six men and women who had been abused by clergy was a powerful combination of upholding the importance of having the letter of the law and displaying the proper spirit behind it.
Jesuit Father Hans Zollner, a German psychologist and psychotherapist who accompanied the two abuse survivors from Germany July 7, said: “This is not only about the letter of the law. This has to come from the heart if this is to really take fruit” and make real, lasting change.
The homily-plan of action repeated calls for zero tolerance and accountability for the “despicable” crime of abuse and underlined continued commitment to vigilance in priestly formation and better policies, procedures and training for the implementation norms.
But most striking that day, some of the visiting survivors said, were not the pronouncements at Mass, but the heart that went into the patient, one-on-one listening later, in private.
While Pope Benedict XVI began the highly symbolic meetings with groups of survivors with his 2008 visit to Washington D.C., Pope Francis took the practice further.
He invited survivors to the heart of the church in Rome for a real sit-down conversation – devoid of aides and officials, for a total of two and a half hours.
“The pope gave so much time. There was no hurry, there was no clock watching. Each survivor got the time they needed to tell the pope their story or whatever they wanted to say,” said Marie Collins, who accompanied one of the two survivors from Ireland for the closed-door papal meeting.
“It was wonderful to see the pope listening so intently, for the survivor to feel heard and have the opportunity to say everything they wanted to say,” said Collins, who is also a survivor of clerical abuse.
The eye contact, the silent reflection and how the pope reacted all showed how “it must have been hugely emotional for him as well as for each of the survivors,” she said.
This seemingly simple feature of limited distractions and formalities ended up being an unexpected turning point for many of the visitors, Collins said, even “life-changing” for another who later spoke to the press.
Collins and Father Zollner, both members of the new Pontifical Commission for the Protection of Minors, said listening not just to groups but to the personal stories of individual survivors is a message to all bishops of what they should be doing in their own countries.
“Now every victim in the world can say, ‘Look, you have to do what the pope did,’” Father Zollner said.
Collins said: “It’s a win-win situation. For the survivors it can be very healing to be listened to” and when church leaders hear and learn more about the nature and effects of the abuse, “it can help them” in seeing what should be done.
But because what can be done and how to go about it are not always clear, dozens of church leaders meet every year for the Anglophone Conference on the Safeguarding of Children, Young People and Vulnerable Adults.
Founded in 1996, the annual conference brings together experts and church delegates from around the globe, to share best practices and develop solid norms in the prevention and handling of the scandal of sexual abuse.
Collins and Father Zollner were among the speakers at the July 7-11 conference, which was being held in Rome the same week the pope met with victims.
Deacon Bernard Nojadera, executive director of the U.S. bishops’ Secretariat of Child and Youth Protection, said the Anglophone conference “is like a think tank” where people can bounce ideas around and have a healthy dialogue.
There can never be a “cookie-cutter approach,” said Francesco Cesareo, chairman of the U.S. National Review Board, because different cultures have different attitudes about how to talk about sexuality.
But, he said, common sense patterns emerge and, with input from the Vatican’s Congregation for the Doctrine of the Faith, which deals with sex abuse cases, the conference “brings a realistic sense of what can be done.”
Bishop R. Daniel Conlon of Joliet, Ill., chairman of the U.S. bishops’ Committee on the Protection of Children and Young People, said in one sense, responding to the abuse crisis should seem very simple. After all, “it is shepherding and a caring for the flock, but the milk is out of the bottle,” he said, adding, “Humpty Dumpty is broke.”
No matter what gets done for victims or perpetrators, “it won’t repair the damage,” he said.
Cesareo said that’s why so much talk must look at the future.
“How will the church prevent the same level of abuse? We should be prepared for the future and that’s more difficult,” he said.
“This is just planting the seeds,” Deacon Nojadera added.
Problems will still exist and some forms of abuse will happen, he said, but the church must have “a culture that’s reliable,” where everyone knows what warning signs to look for and where to get help.
In the church’s decades-long evolution of grappling with the reality of abuse within its own walls, Father Zollner said laws won’t matter unless there is “a whole change of culture within the church,” one that is no longer “drawn to secrecy,” cover-ups and siding with the perpetrator, but to openness to the truth and listening to victims.
Helping church leaders listen to survivors is key to getting leaders to see the importance of norms and enforcing them, he said.
Hearing their stories “changes your life and your attitude toward the whole issue,” he said, “if your heart is not made of stone.”
A heart hardened to human suffering and misery is one of the worst things that can happen, the pope has said, and that’s perhaps why, in his homily for victims, he prayed “for the grace to weep, the grace for the church to weep and make reparation.”
Along with reparation, therapy and support, Father Zollner said, “There is nothing that is more important than an open ear and an open heart, because this is the way reconciliation can start.”
From July 18, 2014 issue of Catholic San Francisco.
– See more at: http://m.catholic-sf.org/ns.php?newsid=30&id=62600#sthash.1x1XFHKU.dpuf
Kathy Picard of Ludlow and Gov. Deval Patrick celebrate bill extending statute of limitations for victims of childhood sexual abuse, Suzanne McLaughlin, Mass Live
/in Massachusetts /by SOL ReformLUDLOW – A new bill has been signed into law by Gov. Deval Patrick that extends the statute of limitations for sex abuse victims to file suit against their abusers.
The new law allows any childhood sex abuse victim up to the age of 53 to file civil charges against their alleged abuser. Prior to the passage of the new law sex abuse victims only had until age 21 to file civil suits against their abusers.
The law was signed by Patrick after it was unanimously approved in the House and Senate.
Kathy Picard, 51, of Ludlow, who says she is the victim of childhood sexual abuse, says she worked for 12 years for passage of the bill. She said she now has filed suit against a male family member who abused her between the ages of 7 and 17.
Victims of childhood sexual abuse should have the right to seek justice, Picard said. She said there is no statute of limitation for charging that someone committed murder.
“Childhood sexual abuse is the murder of a person’s innocence,” she said.
Picard said she told family members about her own childhood sexual abuse which took place between the ages of 7 and 17 and was advised to keep quiet about it.
Picard said she has worked to change the statute of limitations for 12 years.
In 2006, the criminal statute of limitations pertaining to childhood sexual abuse was extended from 15 years after the 16th birthday to 27 years.
“That happened when all the priest abuse (accusations) came out, and I thought, it’s not just priest abuse,” said Picard.
“This new law increases the statue of limitations to 35 years after a victim of sexual abuse’s 18th birthday to file a civil suit against their abuser,” Picard said. “The prior law gave victims only until their 21st birthday to file suit. Giving more survivors until the age of 53 will open doors for many.”
Picard plans to celebrate the new law with a reception on Aug. 23 at Samuel’s Sports Bar at the Basketball Hall of Fame in Springfield. Tickets are $25 per person. Picard said she is trying to raise money to support the curriculum she teachers at the YMCA of Greater Springfield. Picard teaches children how to recognize and report sexual abuse through the Child Help, Speak Up, Be Safe program.
Picard said one in four girls and one in six boys are victims of childhood sexual abuse.
For more information or if you would like to attend, email Kathy Picard at kathychildadvocate@gmail.com