Friday, November 30, 2012

Dissertation on shame. Chapter 28.0 Summary

28.0 Summary


In the following summary I will start by giving a presentation of the settings concerning sexual abuse and the Incest Centre in Vestfold before reviewing the theory that has been explored. Thereafter I summarize the method that has been used in the qualitative investigation and the results of the two quantitative surveys that I have carried out. Finally I conclude with a summing up of the exploration of the concept and phenomenon of shame.

28.1 Settings

Within the context of sexual abuse and the settings of the Incest Centre in Vestfold, this study investigates how people conceive situations which can potentially elicit feelings of shame, the ways in which shameful identities are constructed and maintained or resisted, and the processes by which experiences of shame may lead to a variety of problems.

Child sexual abuse can be understood as a diversity of different actions which can vary from exposure and peeping, photography, verbal communication, touching and intercourse. Where the boundaries go between normal activities that are accepted in a specific culture and what is illegal, are questions that must be answered by the national judicial system. In Norway these different acts and contexts are specified in The Norwegian Crime Law (Straffeloven) chapter 19. Here one finds explanations regarding child sexual abuse which are founded on the acts such as how the genital are touched, intercourse, and masturbation are examples of the concrete actions that that may take place. The gravity of the abuse is defined from how clearly sexual the acts are. The law differs between three different forms for contact: sexual behavior, sexual action, and sexual intercourse.

There seems to be a diversity of definitions of sexual abuse. The Incest Center in Vestfold defines child sexual abuse as:

Child sexual abuse is physical or psychological exploitation of the sexual integrity of children committed by one or more persons whom the child is dependent of or is in a relation of trust with (interview with the leader of the centre 06th of October 2008. My translation.)

Sexual abuse has emerged as one of the major forms of child abuse. This was not the case before 1970. It was not before the late 1970’s that official reports started to grow, and the number of reports grew rapidly. Estimates vary about how many have experienced child sexual abuse as children. Finkelhor (1984) has concluded that studies range from 9 to 52 percent of adult women and 3 to 9 percent of adult men report having been sexually abused as children, either by family members or strangers. DeMause (1991) uses a broad definition of sexual abuse, including not only cases of rape or attempted sexual intercourse, but also genital fondling and other forms of unwanted and intrusive contact behavior. His conclusions show that at least 60 percent of girls and 45 percent of boys have been sexually abused in childhood.  Gilman (1991) has collected and compared 15 studies about reported abuse carried out between 1956 and 1990. The results here vary from 11 to 62 percent of adult women and 3 to 30 percent for adult men. All of these studies, except one, involve both contact and non-contact abuse of the child. Levett (2003) argues that studies, mainly in North America and the UK, commonly suggest up to 54 percent of women have been subjected to child sexual abuse. Levett argues that the two main reasons for the vast differences in reported prevalence of child sexual abuse, is related to the many definitions of sexual abuse and to the different methods used to collect data. The latest Norwegian study I have found concerning sexual abuse has been conducted by Mossige and Stefansen (2007) for Norwegian Social Research (NOVA). 7033 students from secondary school (from 67 schools all over Norway) took part in the study. 22 percent of all girls and 8 percent of all boys reported having experienced less severe forms for sexual abuse, while 15 percent of all girls and 7 percent of all boys reported having experience severe sexual abuse. 9 percent of all girls report having experience attempted rape or have been raped. Less severe forms for sexual abuse consist of indecent exposure and non-contact abuse; while severe sexual abuse consist of contact abuse such as sexual intercourse. This study does not define sexual abuse as in the same way previous studies have done, but uses the description of sexual abuse given the Norwegian Criminal Law concerning sexual crimes.

Sexual abuse is a widespread social problem in our culture and that it is committed mainly by adult men (Sætre, Holter and Jebsen 1986; Finkelhor 1984). This is also confirmed by the Incest Centre in Vestfold where information has been collected about sexual perpetrators since 1991 to the users of the centre in the period 1991-2006. The statistical data from their Annual 2006 (Årsrapport 2006) is based on information given by victims of sexual abuse about 8051 perpetrators (for the period between 1991 and 2006). The statistics show that the overall majority of sexual abuse is committed by male offenders; 91 percent (6621) were reported as male.

The most common consequences from sexual abuse seem to be: strong feeling of guilt and shame, negative self-image, reduced trust in ones self and others, isolation, sexual problems, pain sensations, psychosomatic conditions, anxiety and depression, hallucinations, sleeping problems, self-harm, suicide, re-victimization, and aggressive behavior.

The Incest Centre in Vestfold is built upon humanistic values, which emphasize the inner values. The centre works using a holistic understanding of each person’s need for safety, intimacy, love, belonging, acknowledgement, respect and self-realisation. A basic belief is that each person perceives, understands and interprets his or her own situation best. On the basis of this understanding and insight, each individual decides the best course of action for themselves. An important part of the work is to help the individual increase her or his sense of security and self-respect. The centre is primarily for these groups: sexually abused girls, boys, women and men; the brothers, sisters and relatives of children who have been sexually abused; the spouses or partners and children of abused women and men. The centre’s secondary focus is on the following groups: individuals who have committed sexual abuse against children; other family members of the sexually abused children;  adults; pupils; students; teachers; kindergarten employees; and those working in public institutions who come into contact with incest problems and need instruction and guidance. The goal of the institution is to struggle against incest by agitating for change in the factors in society that contribute to the perpetuation of sexual abuse, such as: victims of sexual abuse should be treated with respect and recognition; support victims and their relatives; break the taboo of shame around sexual abuse by talking about it in newspapers, TV, radio, schools, and so forth.

There are 13 employees at the Incest Centre in Vestfold, 11 women and two men. Since most of the users of the centre are women, is seems natural to reflect this also in the staff. Women helping women, was an important phrase for many years, especially in the early years of the centre, resulting in only women working at the centre. This has changed in recent years. There have been an increasing number of men who seek help for the sexual abuse they have experienced, so now men are welcome to apply for work at the centre and are considered according to qualifications, even though the general policy is still that the majority of the staff is to be women. Three of the workers have no higher education, while one worker has one year of higher education and nine workers have between four and five years of higher education. Of these ten workers with higher education, five have bachelor degrees within various areas such as the teaching profession and two are professional social workers. Three of the workers are qualified therapist with gestalt therapy and family therapy. The leader of the centre is a professional social worker with and educated family therapist. It is no demand that the employees have personal experience with sexual abuse to work at the centre, yet the majority of the workers have such personal experience. Seven of the workers have been sexually abused as children or are parents of children that have been sexually abused. Six of the workers have no personal experience with sexual abuse.

The prime therapeutic tool used at the centre is dialogue. The workers listen to the stories told by the users over and over again. Their concern is with the lives and experiences told by the users. The two most used helping techniques reported by the workers are listening and giving support, just by being a fellow human being. It seems that “being” is more important in this description. Several report that just being there is of decisive significance. Being there means having found the other person and being where this other person happens to be.

The categories which come forth here are made directly from material from users and workers in an Incest Center and not from psychiatric experts. This work ended in seven main-categories; emotions, body, food, self-image, family, sex, and therapy. Reflecting upon these categories over end over again, led to the following final crucial categories which I have chosen to use in this exploration is reflected in the empirical chapters to follow and which are explored in relation to shame:

Self, despair, self-image, pride, false memories, gender difference, depression, betrayal, losing oneself, guilt, anger, embarrassment, self-harm, body, torture, filth, worthlessness, nakedness, looking in the mirror, food, eating disorder, others, the socialization of emotions, revenge, hiding, in the eyes of others, fathers, forgiveness, mothers (Mother-Blaming and Mother-Shaming), brothers/sisters, children (Child-Blaming and Child-Shaming), partners/sex and therapy

Kaare T. Pettersen

Thursday, November 29, 2012

Dissertation on shame. Chapter 27.5 Respect and recognition

27.5 Respect and recognition

The struggle for respect and recognition was spoken of by several of the participants in the interviews. Gunhild, Knut and Ivar discuss the importance of feeling respect; both self-respect and the respect of others.

Gunhild:         To be respected for whom I am. To be seen as I am. Be accepted as I am. I don’t mean that people have to accept all of my reactions. ((Laughs)) When I scream and shout. Yeah. That’s important for me.

Knut:              What is really important for me? You have all of these material objects, but do they have any value in themselves? What does my house, boat, car mean for my self-image? The most important thing is my self respect. I noticed in my healing process, that it was very important what others thought of me. That’s important. There’s something I feel that I keep to myself, the feeling that I have to live up  to others’ expectations. That’s something I dislike. (.)

Ivar:                I expect others to respect me (.) for whom I am.

All three speak of the respect from others for whom they really are. In my opinion this can be difficult to achieve in institutions which do not respect others as they are because they are occupied with the control of those who are asking for help. Zola (1972) argues that therapy has become an institution of social control in the name of health. This has occurred because we define many of the problems of daily life as sickness, and because labelling things as either healthy or sick has become an ever increasing aspect of human existence. He writes that if we search for ways to explain this, we will find that it is rooted in our increasingly complex technological and bureaucratic system. This is a system which has led us down the path leading to the reluctant reliance on the expert. Lazare (1987) argues that patients have a high risk of experiencing shame and humiliation in any form of therapeutic encounter. This is because we commonly perceive illness as rooted in defects, inadequacies, or shortcomings. Visiting therapy institutions often means physical and psychological exposure. Patients respond to the shame and humiliation that is evoked by avoiding therapy experts, withholding information or complaining. It would in my opinion be interesting to conduct a similar exploration of the concept and phenomenon of shame within the settings of a psychiatric institution.

Dagny, who is one of the users of the Incest Centre, explains that helping others with shame is a way of healing her own shame.

Dagny:            ((Nods her head)) The first thing I think of is I’ve done something that I can use to help others. It’s not about me. I’m always last in line. What’s important is helping others. By helping others, I myself am healed.

Finding the other as a helper implies showing oneself to the other. When Dagny opens up for others in my opinion, her own shame is recognized and this contributes to the diminishing of her own shame. Thomas and Parker (2004) argue that in the healing process the focus should be on facilitating the emergence of the self. By strengthening the emergent self, one is able to move it developmentally toward the point where the self becomes secure enough to take responsibility for its actions. Until the self becomes stable enough to distinguish itself from its actions, the person will continue to confuse the two. In working to weaken the grip of shame, emotional work is important and involves nurturing the self so that it is able to move away from the massive self-condemnation that prevents the self from making a realistic assessment of its actions and choosing appropriate responses. Educating new social workers in emotional work seems in my opinion to be an important task.

The healing process which is illustrated in figure 4 is in my opinion both a complicated and a frightening experience of for many, both for those asking for help and the social worker. The social worker should start off carefully, giving the individual the time that is necessary. Linda explains that a lot of people do not dare to come to the Centre for a conversation or even to speak on the telephone. She says that using text messages on her cellular phone is often a good way to make contact with someone who has problems sharing problems with others. Reading and writing messages to each other can be of great help in creating enough security and enable people to come out of their hiding places.

Linda_1:         Using text messages is also a big help. I use them a lot, all the time. ((Places her hand in front of her mouth))…It’s a real good way of helping people. Yeah. I remember one girl here who changed her whole behavior because of text messages. She used to just sit here on the floor. I had her for two and a half years. She just sat on the floor and played with her car keys. She didn’t dare look me in the eyes. So I tried sending her a sms. It worked and she opened up and wrote a whole lot. Talking to me face to face was unpleasant, but reading and writing on the cellular phone worked fine.

Meeting others does not have to be face to face meetings in order to be genuine. Linda illustrates that meeting the other where one is might sometimes require not being able to see the other person. Having conversations over the telephone is a similar form of meeting. Many users of the Incest Centre start their contact and healing process through telephone conversations or even as Linda tells by written text messages over the cellular phone. I agree with Kaufman (1980, 1989) when he argues that the first step in the healing process is to construct a relational bridge. Since nurturing the emerging self is the focus in healing shame, the method must be relational and not behavioral. One has to find the hiding self and restore the relational breach by first asking where the individual is. Shame involves moving away from relationships, hiding. Trying to address guilt instead of shame may be a way of allowing the self to continue hiding. The social worker who moves to affirm and value the shamed self takes the first steps towards strengthening that self. Then the self can is able to reflect upon its deeds with a less punitive evaluation, whether this involves negation of the self or blaming others. Helping others overcome unbearable shame involves building strong relational bonds between the caregiver and the shamed and suffering self.   

Emotional work and acceptance towards people suffering from shame seems in my opinion to be important in the healing process of shame. Larsson and Starrin (1990) argue that skilful helpers use communication of an everyday character as a means of reaching the personal and emotional level in a natural everyday manner and communication dealing with personal and emotional qualities, and they use less communication dealing with facts and practical issues. Margaret explains that abused women and men are often withdrawn when they come for the first time seeking help and security. Helping others with shame involves having experienced the same kind of pain with one’s own body. She argues that personal experience makes a good fellow human being.

Margaret_1:    They are very withdrawn ((Places her hands in front of her)) humiliated, and it’s important that they take one small step at a time and try to zoom in what kind of place this is. They are very afraid of getting in someone’s way here. They are afraid to ask and afraid of doing something wrong. Usually they speak very little. Some of them just sit on the sofa and search for some security. We never start a conversation about abuse or other problems. We always let the users start the conversation…I tell them that they can use me if they want and that I’m here for them…I want to make a difference for them…The most important qualification for working here isn’t whether one has experienced sexual abuse or not, but if you’ve really lived your life. (.) Yeah. That’s what makes a human being a good fellow human being…They find out that they are not alone. They meet others and that means a lot. They meet others who have the same emotions, same thoughts and they start believing in a future. There are many things that fall in place when one dares to share oneself with others.

Margaret stresses that meeting others who have similar emotions and thoughts is important. It takes time to build new relations and Linda says that people may use the Incest Centre as long as they need to.

Linda:                         There are some people who have been users here for ten years. They can use the centre as long as they want.

Several of the participants speak of not being able to trust others and that it takes often a long time to be able to trust others again. This is especially towards significant others. Some speak of mothers who where not there for them in their childhood and miss having a loving and caring mother. Nina tells about a woman she met at the Incest Centre who felt that she had never had a mother, and who now feels as if she has thirteen mothers: all of whom were employed at the centre.

Nina:                           I had one who told me once that she really never felt that she had had a mother, but now she has 13. ((Everyone laughs)) That was cool.

Being a mother for users of the Centre is not a role that is given the employees by the institution but by some of the users, and they see this as something positive. In my opinion the employees seem to be careful not to encourage this role but give the users the opportunity to view the Incest Centre as a home and the employees as caregivers and significant others. Pia feels grateful each time people trust her enough to express their shame and suffering to her.

Pia:                  You get a real good feeling because you’ve helped others with your own costly experience. I tell them so, too, that they give me so much by showing me trust and letting me help them. I’m very grateful to them for that. I never take anything like that lightly. If someone shows me trust umm that’s something I store in my heart. There must be a reason for showing me trust.

Pia sees the trust developing in genuine meetings, she even feels grateful for the trust users show her. Trust is not something the social worker has as an employee at the Centre, but something one receives from the users if one is found worthy of receiving this trust. Building this trusting relationship is important for helping the user to be able to let go of their self-focus and be able to relay on others. Being less self-focused (I-with-me) and more occupied with oneself in the world (I-with-me-in-the-world) will in my opinion lead to a better self-evaluation and make the creation of a new identity possible.  Covert, Tangney, Maddux and Heleno (2003) argue that since shame involves an intense self-focus a person experiencing shame is likely to have difficulty thinking of effective solutions to an interpersonal problem. More importantly, however, the person experiencing shame may have a set of beliefs about himself or herself in the interpersonal domain that makes it difficult for them to use the skills that they actually have. People who frequently experience shame are likely to experience frequent failure in their attempts to solve interpersonal problems, and these experiences are likely to lead to low self-confidence for solving even the common problems and conflicts that occur in interactions with other people. Trude and Ruth discuss how children protect their mothers and how this had been a source of shame for them.

Kaare:             Did you try to protect her?
Trude:                         Yes. ((Nods her head)). Yes. I did then and I still do, even though I tell myself ((Points a finger at her head)) up here, that that’s the way it was and I’ve worked a lot with it, but it’s still lying there under my shoulder blade. I still protect her ((Bites her lips and nods her head)).
Ruth:               It’s weird how we protect our mothers.
Trude:             Yeah. It’s like the last old tie that keeps us together.
Ruth:               And makes you feel shame in a way.
Trude:                         Yeah. That’s something I have to work with. It was (  ) fine that this came up now so I could think about it ((Bites her lips and nods her head))

Linda has a similar experience as Trude and Ruth and protected her mother and it seems that Linda felt sorry for her mother being married to her father. Her father was unfaithful and drank a lot.

Linda_1:         I’ve protected her a lot because umm my father was so rotten to her. He drank a lot and messed around with other women and I really felt sorry for Mom.

Trude, Ruth and Linda were very aware of their parents, especially their mothers. Children’s awareness of their parents needs has been investigated by Jensen, Gulbransen, Mossige, Reichelt and Tjersland (2005) who have carried out a qualitative study of families reporting possible sexual abuse using a sample of 20 families with 22 children in therapeutic sessions. Their results indicate that disclosure is a fundamentally dialogical process that becomes less difficult if the children perceive that there is an opportunity to talk, and a purpose in speaking, and a connection has been established to what they are talking about. It is difficult for children to initiate a conversation about something so secret, confusing and distressing, and where there are few conversational routines in a family for talking about such themes. Children are also sensitive to the needs of their caregivers and fear the consequences of talking about their families and the offenders. Children need a supportive structure or scaffold in order to expose their experiences of child sexual abuse.

Rafferty and Hartley (2006) argue that even though  a lot still remains to be learned about shame it is clear that shame is a painful self-conscious emotion that operates, albeit quietly and hidden, in the development of a wide variety of personal and social problems. It is also clear that, for an individual to be freed of shame, he or she needs to be approached with sensitivity and tact. Perhaps listening to children and adults, with an ear open for the voice of shame may help professionals connect with their shame and release them from their distress. Not to do so would be, in a very real sense, shameful.

In Figure 5 below, figures 1, 2, 3, and 4 are combined to illustrate the struggle for recognition within the context of sexual abuse and the settings of the Incest Centre in Vestfold. This struggle for recognition is influenced by Honneth’s theory of recognition (1996) and is in my opinion a valuable perspective for social work practice (Høilund and Juul 2005; Møller 2008). The figure illustrates that the social-self can be evaluated by self and others in a way that leads to lack of respect and a negative self-evaluation. It is this process, characterized by the destruction of relational bonds, exclusion, hiding, and so forth, that leads in my opinion and based on the interviews in this exploration, to shame. If the person shame is not met with respect and recognition in a dialogical I-Thou meeting with others, then emotions may become repressed and the healing process is obstructed. This means that others are kept at a distance, intimacy is difficult, and the individual objectifies oneself and others. This will often lead in my opinion to a negative spiral, causing more suffering.

Meeting people with problems may be conceived as turning the world upside down; it means moving from being within an I-It relationship to an I-Thou relationship. This can only be accomplished in my opinion through a setting where one is allowed to express one’s emotions, where one is accepted and can carry out emotional work with others when exposing these emotions, and where one gains new experiences that enable the social self to develop in a positive direction.