Institutional dignity and courage in responses to sexual violence

This article will appear in the next issue of the Centre for Institutional Courage’s newsletter.

The Australian Royal Commission into Institutional Responses to Child Sexual Abuse ran from 2013 – 2017 with the mammoth task of examining institutional failures to protect children from child sexual abuse across Australia. In the course of the Commission, over 8000 adult survivors gave verbal testimony about their abuse, while others submitted their stories in writing. In my research on the Royal Commission, survivors described being “treated like the Queen”. At each step of the process, from the very first phone call to the personally signed thank-you card after they spoke, the Royal Commission impressed upon survivors their importance and the worth of their testimony.

When the Royal Commission was first announced, I was a sceptic. It looked to me to be the latest in a long line of public inquiries into institutional abuse that had accomplished little over the years. But I became a convert over the course of the Commission, as it crafted processes and spaces in which survivors felt not just safe but valued even as they described experiences of sexual abuse and betrayal. The Commission was courageous in the way that it conspicuously allied itself with survivors, and challenged those vested interests that prefer silence over justice.

Sexual violation and institutional betrayal are deeply embodied experiences; they are saturated in shame and humiliation, in particular. The Royal Commission offered survivors an opposing experience, one that I’ve come to call “institutional dignity”. In her work, Donna Hicks (Hicks, 2011)(2011, p. 1) defines dignity as “an internal state of peace that comes with the recognition and acceptance of the value and vulnerability of all living things”. For me, this definition captures how survivors felt in the Royal Commission but also the underlying principles that shaped the response of the Commission to them: everyone is valuable and vulnerable simultaneously.

 In my work with research colleagues, including Heather Hall and Rebecca Moran, “dignity” has become an important concept in articulating how we want survivors to feel in institutional responses to sexual violence. I worked as an expert advisor to the Royal Commission and I was struck by how uplifted I felt just being a part of a dignifying institution. For me, the Royal Commission proved that betrayal and failure are not inevitable features of institutional responses to sexual violence, and that institutional responses can be personally and socially transformative – not just for survivors, but for all of us.

Child sexual abuse material: The hidden pandemic

This article appeared in the July edition of ISSTD news.

In the midst of the coronavirus crisis, child sexual abuse material (CSAM) is now recognised as another global epidemic. CSAM includes images, video, text and drawings of children being abused and exploited (previously called “child pornography”). For at least fifty years, CSAM has been a significant social problem, however CSAM victims and survivors have received an uncertain and insufficient response from state authorities. In the 1980s and 1990s, child victims and adult survivors disclosing that images or video were made of their abuse were folded into the “false memory” debates and subject to pervasive disbelief. The argument that victims of sexual exploitation were instead suffering from “false memories” stalled the development of effective state responses to sexual exploitation.  

However, the advent of the internet has made the extent of demand for CSAM undeniable. Over the last decade, reports of CSAM to US authorities have been increasing by 50% per year, due to new technologies that increase the ease and anonymity of CSAM consumption. Large online surveys of men finding that between 2.2 – 4.4% have intentionally viewed CSAM of prepubescent children (Dombert et al., 2016; Seto et al., 2015). With children and adults spending more time online than ever due to coronavirus lockdowns, CSAM and online sexual exploitation have spiked. Finally, governments and the technology industry are being forced to grapple with the global black market in child sexual exploitation. 

In their recent ground-breaking coverage, the New York Times revealed that US authorities received 70 million reports of suspected CSAM in 2018 – 2019. New York Times reporters Michael H. Keller and Gabriel J.X. Dance were the recipients of the 2020 ISSTD Media Award in the written category for their investigative series “Exploited” which documented, for the first time, the failure of state authorities and technology companies to tackle the CSAM epidemic. Their articles focused on victim voices and impact, acknowledging the anxiety and hyper-vigilance of  survivors who know that images and video of their abuse continue to circulate widely.

In the aftermath of this reporting, there have been major shifts in the willingness of policy-makers to hold technology companies to account for escalating reports of CSAM. In March 2020, US Attorney General William P. Barr and other senior government figures met at the White House with the Phoenix 11, an advocacy group of CSAM survivors. You can learn more about the Phoenixx 11 here. The Phoenix 11 described how CSAM victimisation has effected their mental health and physical safety. Alongside ministers from Australia, Canada, New Zealand and the United Kingdom, Attorney General Barr launched the Voluntary Principles to Counter Online Child Sexual Exploitation and Abuse. The Voluntary Principles sets out a baseline for internet companies to deter the use of online services for sexual offending, and acts as a precursor to more significant government regulation. 

In June 2020, the US Senate Judiciary Committee voted unanimously to remove liability protections from online companies that take inadequate action to remove CSAM from their services. This bill has strong bipartisan support and seeks to walk a fine line between protecting the privacy rights of internet users and incentivising the technology industry to act decisively against CSAM. The United Kingdom is developing a legislative approach to “online harms” in which internet companies will have a statutory duty of care to internet users, with children recognised as a particularly vulnerable group.

The technology industry has been vocal in denouncing online child sexual exploitation however they have often been unwilling to prioritise child protection over their business prerogatives. Nonetheless, there are positive signs that Silicon Valley has sensed that governments are no longer turning a blind eye to the extent of online child abuse. This year, the Technology Coalition, a consortium of leading technology companies announced a “Plan to Combat Online Child Abuse” that includes research and development funds for “technological tools” to prevent online sexual exploitation and the publication of an annual progress report charting industry efforts.

Increased awareness of CSAM is bringing to light many of the troubling dynamics disclosed by clients in the complex trauma field, including organised sexual abuse, parental perpetration and sadistic abuse. In a recent survey of 150 adult survivors of CSAM, half of participants identified having a dissociative disorder. Half of participants described organised child sexual abuse, most often identifying one or both parents as the primary perpetrators. Analysis of CSAM photo series finds that images of fathers abusing their prepubescent daughters are the most highly traded and in-demand illegal material. Images of child torture and the abuse of infants are widely available online.

Government and industry action to curb the trade in CSAM is welcome and long overdue. However, as clinicians in the fields of complex trauma and dissociation know all too well, the problem of child sexual exploitation is not primarily a technological one. The children in abuse images and videos have been surfacing in mental health settings for decades. Trauma therapists have much to offer the expanding response to CSAM. As exploited children and adult survivors come forward in increasing numbers, the mental health and psychosocial impacts of CSAM are becoming a global policy priority. State investment in victim-focused measures, including mental health care, is central to a just and comprehensive CSAM response.

Dombert, B., Schmidt, A. F., Banse, R., Briken, P., Hoyer, J., Neutze, J., & Osterheider, M. (2016). How common is men's self-reported sexual interest in prepubescent children? The Journal of Sex Research, 53(2), 214-223.

Seto, M., Hermann, C. A., Kjellgren, C., Priebe, G., Svedin, C. G., & Långström, N. (2015). Viewing child pornography: Prevalence and correlates in a representative community sample of young Swedish men. Archives of Sexual Behavior, 44(1), 67-79.

Truth and neutrality in the treatment of extreme abuse

Below is a copy of an article in the journal Frontiers in the Psychotherapy of Trauma & Dissociation, in which I am commenting on a discussion between Colin Ross and Alison Miller on the role of the “therapeutic neutrality” in the treatment of clients disclosing ritual abuse.

Over the last century, the treatment and science of psychological trauma has unfolded according to three related but distinct areas of inquiry. The first is the therapeutic: What helps traumatised people get better? The second is the empirical or scientific: What do we know about the causes and symptoms of trauma, especially complex trauma? The third area is the political, and it addresses the social implications of the first and second areas of inquiry, namely: What does the study and treatment of trauma teach us about our society, including our past and our future? The successful integration of these three areas has produced striking work that has wrought profound changes in public understanding and clinical practice. Herman’s (1992) Trauma And Recovery and Van der Kolk’s (2015) The Body Keeps the Score come to mind.

However, complex trauma and dissociation are necessarily hidden phenomena, since they are most often caused by violations of trust that are typically secret. This secrecy introduces inevitable uncertainties into our efforts to study the dissociative disorders. In the trauma field, there is no clearer example of the potentially fraught relationship between these three areas than the issues of ritual abuse, mind control and organised abuse (RAMCOA). Since the modern phase of trauma and dissociation treatment began in the 1970s, the pressing needs and frightening disclosures of RAMCOA clients have not only challenged existing treatment paradigms; they have called into question what we really know about the extent of abuse in our communities, and indeed the very nature of our societies (Schwartz, 2000; Scott, 2001).

Contradicting optimistic narratives of modernity and progress, severely traumatised children and adults describe their sexual exploitation within terrorising families and black markets in full view of uncaring institutions and punitive bureaucracies. It is not uncommon that their disclosures suggest the active collusion or corruption of authority figures and agencies that are otherwise tasked with our protection and safety. While the majority of mental health professionals find RAMCOA clients to be credible (Bottoms, Shaver, & Goodman, 1996; Ost, Wright, Easton, Hope, & French, 2013; Schmuttermaier & Veno, 1999), they are frequently not in a position to substantiate such claims. In the 1990s, when some clinicians went public with wide-ranging assertions about RAMCOA, the absence of definitive evidence provided an opportunity for sceptics to attack the entire project of trauma treatment (Brown, Scheflin, & Hammond, 1998).

While the intensity of the so-called “memory wars” has since faded, the therapeutic treatment of RAMCOA still has a troubled relationship with the empirical (“is this true?”) and the political (“what does this mean?”). Mental health professionals have sought to resolve this tension in a variety of ways. Some have chosen to focus on the therapeutic, and to defer unresolved empirical and political questions. On the face of it, this seems like a reasonable position. After all, treatment and recovery should be the first priority of trauma therapists. This position has been widely endorsed since the mid-to-late 1990s by clinicians who agreed that, despite encountering evocative evidence of extreme abuse in the course of treatment, the veracity of RAMCOA disclosures was unclear (e.g. Fraser, 1997; Ross, 1995).

The problem is that questions about the existence of RAMCOA persistently intrude into treatment, since many clients describe ongoing organised abuse (Miller, 2012). The framing of “ritual abuse” as merely a matter of “recovered memories” has been shattered by the significant proportion of clients who describe a lifetime of sadistic abuse continuing at the time of treatment. In their guidelines on the treatment of dissociative identity disorder, the International Society for the Study of Trauma and Dissociation (ISSTD) (2011) acknowledges that it is “not unusual” for adult clients disclosing organised abuse to reveal that “they are still being exploited by one or more primary perpetrators” (p 168). Therapists are thus forced to address memories of past abuse alongside potentially related abuse experienced in current reality. If the therapist concludes that the client is disclosing current RAMCOA victimisation, then she or he may have to grapple with the political dimensions of health and legal systems that are often unresponsive or retraumatising for survivors of extreme abuse (Salter, 2017).

Some therapists have extrapolated what they have learnt in therapeutic contexts about RAMCOA in order to understand its empirical and political aspects. This process has produced work of tremendous compassion and insight. For instance, Harvey Schwartz’s (2013) book The Alchemy of Wolves and Sheep is a remarkable discussion of the social and moral implications of RAMCOA. However, efforts to grasp the “big picture” of RAMCOA are diverse and can introduce contradictory and heavily disputed assumptions. The ISSTD has often struggled to contain the many different views about the social and political implications of RAMCOA disclosures, As the Chair of the ISSTD RAMCOA Special Interest Group in 2018, my most difficult task was to try to hold a space for the therapeutic and scientific discussion of RAMCOA that was not overwhelmed by strongly held spiritual beliefs or unproven historical claims.

Unlike the majority of my fellow ISSTD members, my focus as a criminologist is on the empirical and political, rather than the therapeutic, aspects of complex trauma. I participate in academic and law enforcement discussions about organised crime and child sexual exploitation while also taking seriously the descriptions of RAMCOA provided by survivors. The good news is that we know considerably more now about subcultures of sadistic paedophilia and the plight of sexually exploited children than we did when the “memory wars” first broke out. We know today that the disclosures of ritually abused children and adults in the 1980s and 1990s heralded the findings of current investigations into sadistic abuse, cover-ups and networks of abusers online and offline. The accounts of RAMCOA clients in therapy are not incongruous with the contemporary study of child sexual exploitation. To the contrary, the developing evidence base has increased, not decreased, the credibility of RAMCOA disclosures.

We should not remain trapped within the strictures of the “memory wars” of the 1990s, which were accelerated, to a significant degree, by a lack of scientific knowledge about child sexual abuse as a whole. It is useful to consider just how little was known at the time about organised abuse or child exploitation. Therapists working with RAMCOA clients would benefit from current research on organised crime and sexual exploitation, which resonates so strongly with the experiences of their clients (e.g. Canadian Center for Child Protection, 2017; Salter, 2013; Schröder, Nick, Richter-Appelt, & Briken, 2018).

Each domain of inquiry into trauma – therapeutic, empirical and political – is interlinked but also distinct. They can inform and shape each other in productive ways. In light of current evidence, we should be willing to revise previous assumptions and scepticisms about RAMCOA, and to recognise the partiality of our respective experiences and expertise. It is apparent that psychotherapy is one of the few spaces in which victims and survivors of RAMCOA can find solace and pursue their rights to health, safety and self-determination. The insights gained by trauma therapists have made invaluable contributions to our understanding of child sexual exploitation as a form of organised crime, which in turn shapes policy responses. The significant improvements in public attitudes and services for trauma survivors over the last century has been wrought, to a significant degree, by the public and political activities of trauma clinicians, often in partnership with survivors of abuse and violence (Fassin & Rechtman, 2009; Whittier, 2009). In this way, the relationship between the therapeutic, empirical and political can be mutually enriching and productive.

Rather than insisting on unproductive dichotomies of “belief” or “scepticism”, contemporary awareness of extreme abuse compels us, especially the therapists among us, to “immerse ourselves in the contradictions of narration and history”, as Grand (2000, p 43) puts it in her reflections on clinical encounters with evil. These contradictions are manifestly evident in the maelstrom of dissociated recollections and disabling pain that accompanies the emergence of RAMCOA narratives. As expert bystanders, then, with much humility and reflection, we must maintain our critical faculties alongside our openness to the unknown.

 Bibliography

 Bottoms, B. L., Shaver, P. R., & Goodman, G. S. (1996). An analysis of ritualistic and religion-related child abuse allegations. Law and Human Behavior, 20(1), 1–34.            

Brown, D., Scheflin, A. W., & Hammond, D. C. (1998). The contours of the false memory debate. In D. Brown, A. W. Scheflin, & D. C. Hammond (Eds.), Memory, trauma treatment and the law (pp. 21–65). New York; London: W. W. Norton and Company.

Canadian Center for Child Protection. (2017). Survivor's Survey Preliminary Report. Winnipeg. https://protectchildren.ca/pdfs/C3P_SurvivorsSurveyPreliminaryReport_en.pdf

Fassin, D., & Rechtman, R. (2009). The empire of trauma: An inquiry into the condition of victimhood. Princeton: Princeton University Press.

Fraser, G. (Ed.) (1997). The dilemma of ritual abuse: Cautions and guides for therapists. Washington: American Psychiatric Press.

Grand, S. (2000) The reproduction of evil: A clinical and cultural perspective, Hillsdale, NJ: Analytic Press.

Herman, J. (1992). Trauma and recovery. New York: Basic Books.

ISSTD. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115–187.

Miller, A. (2012). Healing the unimaginable: Treating ritual abuse and mind control. London: Karnac.

Ost, J., Wright, D. B., Easton, S., Hope, L., & French, C. C. (2013). Recovered memories, satanic abuse, dissociative identity disorder and false memories in the UK: A survey of clinical psychologists and hypnotherapists. Psychology, Crime & Law, 19(1), 1-19.

Ross, C. (1995). Satanic ritual abuse: Principles of treatment. Toronto: University of Toronto.

Ross, C. (2018) The Potential Relevance of Maladaptive Daydreaming in Treatment of Dissociative Identity Disorder in Persons With Ritual Abuse and Complex Inner Worlds, Frontiers in the Psychotherapy of Trauma and Dissociation, 1(2):160–173, 2018

Salter, M. (2013). Organised sexual abuse. London: Glasshouse/Routledge.

Salter, M. (2017). Organized abuse in adulthood: survivor and professional perspectives. Journal of Trauma & Dissociation, 18(3), 441-453.

Schmuttermaier, J., & Veno, A. (1999). Counselors' beliefs about ritual abuse: An Australian Study. Journal of Child Sexual Abuse, 8(3), 45–63.

Schröder, J., Nick, S., Richter-Appelt, H., & Briken, P. (2018). Psychiatric Impact of Organized and Ritual Child Sexual Abuse: Cross-Sectional Findings from Individuals Who Report Being Victimized. International journal of environmental research and public health, 15(11), 2417.

Schwartz, H. L. (2000). Dialogues with forgotten voices: Relational perspectives on child abuse trauma and the treatment of severe dissociative disorders: New York: Basic Books.

Schwartz, H. L. (2013). The Alchemy of Wolves and Sheep: A Relational Approach to Internalized Perpetration in Complex Trauma Survivors. London and New York: Routledge.

Scott, S. (2001). Beyond disbelief: The politics and experience of ritual abuse. Buckingham: Open University Press.

Van Der Kolk, B. (2015). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. London: Penguin Books.

Whittier, N. (2009). The politics of child sexual abuse: Emotion, social movements, and the state. Oxford and New York: Oxford University Press.

Brett Kavanaugh’s nomination and the moral context of trauma science

Below is a copy of my editorial in a forthcoming issue of the Journal of Trauma and Dissociation.

The fraught process surrounding the recent nomination of Brett Kavanaugh to the US Supreme Court was a spectacular deployment of institutional power to suppress good faith allegations of sexual violence. Trauma survivors and their allies have been shaken by the public scorn and victim-blaming that occurred when a childhood acquaintance of Kavanaugh’s, Christine Blasey Ford, alleged she had been sexually assaulted by him while they were at high school. Kavanaugh denied the allegation and US President Donald Trump firmly supported him. The matter only became more heated when, after Ford agreed to testify publicly to the Senate Judiciary Committee, two other women come forward with allegations of sexual assault and improper conduct by Kavanaugh.  

The response of Kavanaugh and his supporters was replete with the rhetoric of denial. Kavanaugh variously characterized the allegations as part of a “coordinated effort” and “conspiracy” to destroy his reputation and prevent his nomination. President Trump agreed that the three women describing abuse by Kavanaugh were politically motivated. He went on to suggest that one woman “has nothing” on Kavanaugh because she “admits she was drunk” at the time of the alleged assault. Conservative media commentators speculated that Ford was suffering from “false memories” of rape, or had mistaken her actual attacker for Kavanaugh. Such language, reverberating from the White House and its spokespeople and advocates, represents a sustained campaign of institutional betrayal that only compounds the trauma of sexual assault (Smith & Freyd, 2013), consonant with other policy positions that have profoundly traumatised the vulnerable (Smidt & Freyd, 2018).

The proposition that allegations of sexual violence are motivated by animus or the product of confabulation or “false memories” has a long and shameful history (Campbell, 2003). Movements against sexual assault and child abuse have routinely been accused of hiding an ideological agenda, or creating the conditions for false allegations by confused women and children. The conflicts surrounding Kavanaugh’s appointment have highlighted the persistence of a culture of disbelief. However, it is notable that the attempts by Kavanaugh’s supporters to invoke pseudo-scientific explanations for Ford’s allegation found considerably less purchase in the mass media than they might have in the past. Questions about the integrity of Ford’s memory were largely limited to right wing and conservative media, and were rejected in statements from the International Society for the Study of Trauma and Dissociation and the American Psychological Association. Progress against the institutionalized mechanics of denial and unaccountability is substantive although clearly incomplete (Brand & McEwen, 2016). 

The most impactful evidence of Ford’s credibility was undoubtedly provided by Ford herself. Her dignified and unwavering testimony to the Senate Judiciary Committee drew on her expertise as a psychology professor to carefully explain the science of memory. The persuasive nature of Ford’s statement, and the accounts of other women who also alleged drunken assaults by Kavanagh, did not prevent his appointment but it certainly stalled it. After Ford’s testimony, a survey of over 1100 American adults found that 45% believed she was telling the truth, compared to 33% who believed Kavanaugh, with 22% unsure (Montanaro, 2018). This result was an improvement on the 32% of the public who believed her prior to her testimony. Ford’s increased support indicates a significant shift in public attitudes since 1991, when Anita Hill testified that then-Supreme Court nominee Clarence Thomas had sexually harassed her. After Hill’s testimony, less than a quarter of Americans believed her while 58% supported Thomas (Montanaro, 2018).

 The response to Ford’s testimony was so positive that Kavanaugh’s appointment process was put on hold for one week as the FBI conducted a limited investigation into her claims. Predictably, this manifestly inadequate investigation did not corroborate Ford’s allegation, providing justification for a slight majority of senators on the judiciary committee to confirm Kavanaugh. Trump subsequently mocked Ford in public and apologized to Kavanaugh for the “terrible pain” caused to him by her allegations. Despite an outpouring of support for her, Ford and her family were forced to leave their home for an undisclosed location, facing death threats.

 The highly polarized response to Ford’s allegation was, of course, a politically partisan phenomenon, reflecting deep divisions between the major parties and their supporters. However, I would suggest that it also highlighted a collision between two opposing ethical and moral visions. If ethics refers broadly to our conception of the ‘good life’, then morality refers to what we owe to others in our pursuit of that life. Driving much of Kavanaugh’s support was the potential for a conservative majority on the Supreme Court with far-reaching ethical implications, particularly for opponents of abortion. Morally, Kavanaugh’s supporters argued that he was due the presumption of innocence and protection from unfounded reputational damage. On the whole, they presented an ethical framework steeped in established juridical traditions, in which only criminally prosecuted allegations should obstruct the progression of a man of otherwise good standing.

 Ford’s supporters advanced an alternative ethical vision: a world in which people who speak up about betrayal and sexual violation are to be taken seriously. To them, Ford deserved respect and a fair hearing in the venue of her choice, whether that was the media or a senate committee. She did not seek a criminal investigation of Kavanaugh and, on the whole, that choice was respected; the reasons why a girl or woman would not report sexual assault to the police seemed widely understood. The ethical consensus in which Ford’s support was embedded represents a coherent worldview that has developed over time, linked indelibly to the feminist movement but also the efforts of the trauma field to legitimize testimony of sexual violence. And while Kavanaugh’s appointment indicates the institutionalization of the first ethical perspective, at least within this US administration, the second vision endures and arguably is growing in visibility and appeal. The one year anniversary of the #MeToo movement has passed with unprecedented global attention to the power differentials that camouflage sexual violence and harassment, particularly by perpetrators of high status.

 While the science of trauma and memory featured in the debate over Ford’s allegations, it was far from the deciding factor. At the core of the conflict between Ford and Kavanaugh was not a disagreement over data and facts but rather two opposing moral systems: the first, a kind of legal positivism, in which only allegations tested in court are ‘real’, and the second, a socially situated understanding of the value of testimony of violence and abuse. It was ultimately these opposing frameworks that provided the organizing principles for the various facts available to the public and the judiciary committee, producing narratives that  ‘made sense’ out of Ford’s and Kavanaugh’s accounts in very different ways. These frameworks are not neutral or objective but rather they are produced and promulgated by political groups and social movements as their members pursue, and defend, their understanding of the ‘good life’.

 Attacks on the credibility of trauma testimony and treatment have often called into question the scientific rigor of the trauma field, and these criticisms have been usefully answered by a sustained multi-pronged program of empirical research. Ford’s careful explanation of the science of trauma and memory in her testimony to the judiciary committee was an important moment, highlighting just how far the trauma field has come since the ‘memory wars’ of the 1990s. Her detailed scientific exposition not only leant empirical substantiation to her account but it impressed upon the senators, and the viewing public, that she was a person of serious intent. However, she presented this scientific information as part of what was undoubtedly a particular ethical project of her own, born of a sense of responsibility to report relevant information about a person about to be appointed to a position of great power. I would suggest that it was the embeddedness of trauma science within Ford’s impressive ethical commitment and bravery that made it so striking and persuasive.

 In their history of trauma, Fassin and Rechtman (2009) argue that prevailing moral sentiments have powerfully shaped trauma science and practice over the last one hundred years. The ways in which trauma is understood, and the forms of inquiry that are permitted into it, reflect shared attitudes towards human tragedy and suffering. Given the recurrent attacks on trauma therapists and researchers, it is often tempting to hide ‘behind the data’; to characterize the study and treatment of trauma and dissociation as an area of scientific inquiry like any other, founded on testable hypothesis to be examined over time. However, such a flight into empiricism ignores the broader moral questions that can frame traumatized people as malingering or malicious in their allegations, and cast trauma professionals into suspicion. Moral debates delineate the boundaries within which trauma can be recognized and addressed, and ultimately determine whether our work will be impactful or undertaken at all. It is not terrain that should be ceded.

 Whether we like it or not, to speak truthfully about the conditions and symptoms of trauma has an inescapably political aspect. Inequalities of power – whether of age, gender, race, class, ability or some other axis – are the medium within which trauma and dissociation grows. Our efforts to understand, treat and prevent trauma inevitably challenges the status quo and reveals its hypocrisies and secrets. The figure of Christine Blasey Ford standing against the wishes of the entire US political apparatus is as appropriate a metaphor as any for the position that many find themselves within when they articulate traumatic truths. We can feel isolated and exposed in a confrontation with treasured social institutions, powerful people or widespread but wrongheaded assumptions and beliefs. In that position, it is our moral convictions that sustain us, and draw other people to our side. The profound courage shown by Ford has left an impression that will remain long after the details of this historical moment have faded in memory. Courage is also, Smith and Freyd (2014) suggest, what enables us to “study what we wish did not exist”; that is, to inquire into the acts and impacts of trauma and listen to the voices of survivors who might otherwise go unheard.

 While I hesitate to argue that we can read life lessons directly from research findings, it does appear to me that the overall direction of trauma research and treatment trends in a particular moral direction. If we seek to find opportunities for trauma survivors to recover and live well, and if we want to promote the conditions in which people are not traumatised in the first place, then we are necessarily advancing moral propositions about human happiness and flourishing. Research on trauma, recovery and psychological wellbeing consistently finds that human beings thrive when we are embedded in emotionally rich, mutual and equitable relationships. This conclusion furnishes us with a powerful and, I think, very appealing image of a good life – one characterized by dignity, equality, accountability, and shared recognition - that the trauma field should not hesitate in articulating clearly. Political theorist Alford (2016) suggests that a key reason for the expanding public interest in trauma science is precisely because the concept of ‘trauma’ provides a rare acknowledgement of human relationality and vulnerability in a culture that is exhaustively individualistic and atomizing.

 When a person like Christine Blasey Ford stands up to testify to a traumatic event, in opposition to incredibly powerful forces, we can recognize this as a courageous step in the fulfillment of a moral vision that we also have a stake in. The visceral and hate-filled response that has driven her, and her family, from their home is stark evidence of the cost paid by people who challenge the structures of traumatisation. Such costs have, of course, been visited in the past on trauma therapists and researchers whose ethical and scientific convictions have also bought them into conflict with vested interests. However the tremendous support that rallied around Christine Blasey Ford, and that recognised and celebrated her bravery in stepping forward with her story, indicates a growing consensus that opposes traumatizing social formations and seeks an alternative. Trauma research and theory, I would argue, is well placed to elaborate on what those alternatives might be.

Bibliography

Alford, C. F. (2016). Trauma, Culture, and PTSD. New York: Palgrave Macmillan.

Brand, B. L., & McEwen, L. (2016). Ethical standards, truths, and lies. Journal of Trauma & Dissociation, 17(3), 259-266.

Campbell, S. (2003). Relational Remembering: Rethinking the Memory Wars. Oxford: Rowman and Littlefield Publishers, Inc.

Fassin, D., & Rechtman, R. (2009). The Empire of Trauma: An Inquiry into the Condition of Victimhood. Princeton and Oxford: Princeton University Press.

Montanaro, D. (2018, October 3). Poll: More believe Ford than Kavanaugh, a cultural shift from 1991. NPR. https://www.npr.org/2018/10/03/654054108/poll-more-believe-ford-than-kavanaugh-a-cultural-shift-from-1991

Smidt, A.C. & Freyd, J.J. (2018) Government-mandated institutional betrayal, Journal of Trauma & Dissociation, 26(5), 491-499

Smith, C. P., & Freyd, J. J. (2013). Dangerous safe havens: Institutional betrayal exacerbates sexual trauma. Journal of Traumatic Stress, 26(1), 119-124.

Smith, C. P., & Freyd, J. J. (2014). The courage to study what we wish did not exist. Journal of Trauma and Dissociation, 15(5), 521-526.

Examining our history and moving forward

I wrote a newsletter article for the International Society for the Study of Trauma and Dissociation reflecting on one of the most controversial issues in the study of complex trauma and dissociation: ritual abuse and 'mind control'. The article is available online here or you can read the text below.

I was a teenager when ritual abuse was first reported in Australia. A series of newspaper articles in the mid-1990s claimed that women were entering psychotherapy only to ‘recover’ memories of grotesque and improbable abuse. The general thrust of coverage was that the movement against child abuse had gone too far, and that therapists and social workers were encouraging, and sometimes forcing, children and women to imagine abuse that had never happened.

I was entirely unprepared when, only a few years after the publication of those articles, a friend began disclosing ritual abuse in the context of a paedophile ring. These disclosures occurred without facilitation or encouragement by a mental health professional, and they did not conform to mass media warnings about ‘false’ and ‘recovered’ memories. She had never ‘forgotten’ her abuse and she was reporting attacks in the present that left behind undeniable marks and injuries.

Her disclosures set me on the path to a career as a criminologist specializing in the study of organized child sexual abuse. I now chair the Ritual Abuse, Mind Control and Organised Abuse Special Interest Group (RAMCOA) which is full of people just like me: people who unexpectedly encountered survivors of extreme abuse and have sought to understand and address their particular needs. The SIG includes an important cohort of therapists who are also survivors, driven by personal experience and professional commitment to provide care for others who share their history.

Over the last few years, there’ve been moves afoot within the ISSTD to revisit and come to grips with the fractious legacies of the ‘memory wars’, including controversies over ritual abuse and mind control. I listened with great interest at the national ISSTD conference in Chicago this year as a number of ‘veterans’ of those wars shared their reflections on that time. It’s been illuminating to hear first hand accounts of the formation of the ISSTD and the costs born by those who first tried to articulate the unspeakable: the intentional inducement and manipulation of dissociation in children for the purposes of sexual sadism and exploitation.

However, if the evolution of trauma treatment has taught us anything, it’s that revisiting the past is not inherently therapeutic. Revisiting needs to be an opportunity for reframing and reprocessing, or else we may only reproduce the same conflicts and painful divisions. We can use contemporary knowledge and evidence of child sexual exploitation to develop new insights into earlier debates over ritual abuse and mind control

It has long been observed that virtually all survivors of ritual abuse and mind control report that their sexual abuse was photographed and videotaped (e.g. Snow & Sorenson, 1990). This observation is affirmed by contemporary digital evidence in the form of online child exploitation material, as well as research with survivors. The size of the market in child abuse material was significant prior to the internet, and included semi-commercial production within developed countries (Berenbaum et al., 1984). However, with the advent of the internet, demand for child abuse material has grown exponentially. By mid 2017, the world’s largest law enforcement database of child abuse material, the U.S. Child Victim Identification Program, had reviewed more than 207 million images and videos of abuse.

Content analysis finds that over half of online child abuse material depicts explicit sexual activity and assaults, and 2% depict the kinds of torture disclosed by survivors of ritual abuse: bestiality, bondage, weapons, defecation/urination (Canadian Centre for Child Protection, 2016). Over two thirds of abuse material appears to have been manufactured in a home setting. In 2017, the Canadian Center for Child Protection published the findings of a survey of 150 survivors of child sexual abuse imagery (Canadian Centre for Child Protection, 2017). Their findings include that:

• Half of survivors were victims of organized sexual abuse: that is, a group or network of offenders.
• In the majority of organized abuse cases, the primary perpetrators were one or both parents.
• Victimisation in organized abuse tended to begin before the age of four and continue into adulthood.
• A significant group of survivors reported torture involving rituals, electroshock and near-drowning (Canadian Center for Child Protection, 2017).

This data affirms to a significant degree the pattern of abuse that has been consistently disclosed by survivors of ritual abuse and mind control. It is becoming apparent that demand for child abuse material is being met by organized perpetrator groups involving parents who use a range of techniques to traumatise their children from infancy into compliance with sexual exploitation. From the vantage point offered by contemporary research, it would seem that the emerging professional field of trauma and dissociation in the 1970s and 1980s provided a space in which a subterranean criminal phenomenon – the extreme abuse of children for mass consumption – could surface and be recognized for the first time.

Something else that we learn from trauma therapy is that the retelling of history is shaped by inequities of power. Some people are permitted to remember but others are not, and some stories are legitimized while others never gain a hearing. At the moment, the authorised perspective on the ‘memory wars’ over the credibility of ritual abuse and mind control tends to be (mostly) white, (mostly) male and (mostly) medical, characterized by a renewed call for therapeutic neutrality to avoid the supposed excesses of the ‘believers’ and the ‘sceptics’ of the 1980s and 1990s. Underlying this call is a soothing agnosticism over the reality or otherwise of extreme abuse; an agnosticism that could have been justified twenty-five years ago perhaps, but not today.

There is another set of histories and perspectives on ritual abuse and mind control that paint a more complex picture. The narrative of rational clinicians standing firm against ideology and hysteria casts a pejorative shadow over the struggles of survivors, activists and their allies who forced ritual abuse and mind control onto the therapeutic agenda. Listening to these stories will not only provide us with richer insights into the ‘memory wars’ but will broaden the field of those who are authorized to provide the ‘official’ history of research and practice in trauma and dissociation.

A full accounting of the ‘memory wars’ might even acknowledge the experience of those people, like my friend, whose brutal exploitation continued unabated during the 1990s, even as the very existence of her abuse was being debated in the mass media and professional literature. Perhaps, one day, we might find space to grieve for the extraordinary tragedy that we were first alerted to ritual abuse and mind control over a quarter of a century ago, and we have lost another generation to inaction and disbelief.

I am one of many who believe that we have reached a tipping point in relation to ritual abuse, mind control and organized abuse. In my work as a criminologist, I am in regular contact with professional stakeholders involved in the detection and disruption of online and organized sexual abuse. Ritual abuse and mind control do not surprise them. Slowly but surely, sadistic and exploitative family networks are being uncovered and broken up through careful investigation and prosecution. We are beginning to reckon with paedophilic subcultures that use dissociation as an instrument of control.

The most appropriate stance that we can take, I think, when we look back at early attempts to grapple with ritual abuse and mind control is grateful appreciation. Like any early area of inquiry, there were missteps and mistakes. But we would not be where we are today without the dogged commitment of those therapists, survivors and activists who refused to let the extreme and bizarre excesses of human cruelty be buried by social and professional incredulity. Their efforts, I believe, have been vindicated.

Bibliography

1. Berenbaum, Tina M., Burgess, Ann Wolbert, Cucci, Joseph, Davidson, Howard A., McCaghy, Charles H., & Summit, Roland C. (1984). Child pornography in the 1970s. In A. W. Burgess & M. Lindeqvist Clark (Eds.), Child pornography and sex rings (pp. 7–23). Lexington MA; Toronto: Lexington Books.
2. Canadian Center for Child Protection. (2017). Survivor’s Survey Preliminary Report. Winnipeg: Canadian Centre for Child Protection.
3. Canadian Centre for Child Protection. (2016). Child sexual abuse images on the Internet: http://www.protectchildren.ca/pdfs/CTIP_CSAResearchReport_2016_en.pdf
4. Canadian Centre for Child Protection. (2017). Survivor’s Survey: Executive Summary. Winnipeg: Canadian Center for Child Protection.
5. Snow, B., & Sorenson, T. (1990). Ritualistic child abuse in a neighborhood setting. Journal of Interpersonal Violence, 5(4), 474–487.

Ongoing media advocacy: Responding to disinformation

On 12 April, the Australian news site Mamamia published an article about a case of organised sexual abuse in Mineola, USA, that had been prosecuted several years ago. A group of parents in a 'swingers' group were found to be drugging and abusing their children at 'parties'.

Ten people were imprisoned for offences against five children, including six guilty pleas. Upon release, one of the convicted men has reunited with his now teenaged daughter, and together they are campaigning for his innocence. On this basis, the article suggested that all charges in the case were miscarriages of justice.

I wrote to the editor of Mamamia to complain, arguing it was irresponsible for the article to draw such a conclusion when the majority of victims maintain their testimony, and ten convictions were secured in the case. Mamamia retracted the article and gave me right of reply. You can read my article below, or access it on their website here.

As a criminologist studying organized child sexual abuse, I sometimes feel like I live in the ‘upside down’, the shadow world parallel to our own in the TV series Stranger Things. In the TV series, the ‘upside down’ looks like our own world, but darker and filled with unpredictable terror. Kids disappear into it sometimes, and occasionally something awful slips out of it to disrupt our brighter universe. For the most part, people would prefer not to admit it exists.

I’ve interviewed over forty Australians who report being abused by groups or networks as children.  I’ve met many, many more survivors from around the world. Each of them has escaped from their own ‘upside down’: a dark childhood ruled by abusive adults demanding their compliance and silence. Far too often, their own parents orchestrated their abuse. We now know that parents are amongst the most prolific producers of child abuse material. 

Every victim of child sexual abuse survives in his or her own way, often by pretending the abuse isn’t happening. The majority of sexually abused kids never disclose at the time, but even when they do, research suggests that most children are not believed.   When a child offers us a glimpse into their ‘upside down’, it seems that most of us don’t want to help them, or don’t know how. 

Trapped between two worlds – the shadow world of their abusers, and the world that turns a blind eye to it – is it any wonder that some survivors also turn away from knowledge of their abuse? One study of women with documented histories of sexual abuse found that one third did not remember the abuse seventeen years later.  Of those that did remember, 16% said there were times where they did not recall the abuse. Many could not fully recall what had happened.

The traumatic dynamics of abuse and memory make investigating and prosecuting complex sexual abuse cases very difficult. Profoundly abused children are the least likely to disclose their abuse, and even where there is forensic evidence, they may grow up having forgotten or even denying the abuse took place. Some may even ally themselves with their abusers who reinforce the victim’s desperate wish that the abuse didn’t happen. These impulses are understandable and require a compassionate and sensitive response.

Unfortunately, there are many myths circulating in the media and community that reinforce individual and collective denial. Since the 1980s, journalists have claimed that children make up stories of sexual abuse, and are encouraged or even forced to do so by social workers, therapists and police. It has become an item of faith amongst skeptics that investigators have a perverted interest in sexual abuse cases, to the point of inventing them.

This is ridiculous. When you work in the field of sexual abuse, the very last thing you want to hear is that another child has been hurt. However, when a child discloses sexual abuse, we have to take them seriously. Children are far less suggestible than people realize,  and disclosures of sexual abuse should always be listened to and reported to the correct authorities. Child protection practices and interviewing techniques with children are constantly being studied and improved to ensure that children’s evidence is as robust and accurate as possible.

Nonetheless, people still don’t want to believe the ‘upside down’ world of sexual abuse exists. They don’t want to hear about parents who abuse their kids and allow other people to do so, advertising them online,  making them available for money  or circulating abuse images and video of them. One way to make this awful knowledge disappear is to attack the messenger, and blame the people who support child and adult survivors and investigate their allegations. This has become a common technique of denial and it’s not going away anytime soon.

There’s a moment in Stranger Things where one of the young protagonists confronts a monster from the ‘upside down’, and it invades and overwhelms him. When I’m confronted by people who deny the seriousness of sexual abuse, I wonder if that’s what they are afraid of too: that they will somehow be infected by the fear and the terror that comes with severe sexual abuse. However, it’s only by sharing in the knowledge that such abuse exists that we can understand what victims are trying to tell us, and hold perpetrators to account. 

Through the work of the Royal Commission into Institutional Responses to Child Sexual Abuse, Australia has proven that we can bring victims and survivors of sexual abuse in from the cold. We can look into the worst aspects of human behavior and come out the other side armed with new insights and tools to prevent abuse and support victims. As we move forward, we should stay mindful of our own instincts for denial and minimization. There are still many kids trapped in the ‘upside down’, and many perpetrators who would prefer that we didn’t know it exists.

Interpol conference

I recently attended the annual meeting of the Interpol working group on crimes against children, which brings together police, non-government organisations and others from around the world to share their experience and developments in the prevention, investigation, prosecution and management of child abuse. The efforts of the Specialists Group have increasingly turned to online child sexual exploitation and the disruption of child abuse material. I was asked to attend and present a seminar based on my research on adult survivors of organized child sexual abuse.

The conference was held at Interpol headquarters in Lyon, France. Attendees came from all around the world, and the conference was held in a room surrounded by soundproofed booths for translators. As presentations were given in a variety of languages, we all used headsets to access real-time translation. The conference was structured around four sub-groups: child victim identification, internet-facilitated crimes against children, serious and violent crimes against children, and sex offender management. It was heartening to see the level of activity and commitment evident in combatting child abuse around the world.

There was a clear distinction between the child abuse challenges facing middle and low income countries, such as Kenya or Thailand, and those facing high income countries such as Canada and the United States. Representatives from lower income countries spoke about the difficulties of sustaining basic child protection infrastructure to address the prevalence of abuse and neglect, including increasingly complex forms of child sexual exploitation from perpetrators at home, abroad and online. These presentations highlighted significant resourcing problems for developing countries in preventing and investigating child abuse, and the need for ongoing international aid and collaboration.

In contrast, police and non-government representatives from high-income countries discussed high-tech interventions in online child abuse, including the development of artificial intelligence and algorithms to detect and remove child abuse material, and assist in the identification of victims. Their focus on online exploitation and technological interventions is indicative of the considerable investment of police resources in internet safety over the last twenty years, led by public concern in Western countries about online child abuse offenders. While policing efforts in this arena have led to important breakthroughs in online detection and disruption of abuse, there has not been an equivalent response to the evidence that most abuse networks operate ‘face to face’ even where they use technology in abuse. The fields of social work, mental health and child protection were notably absent from these presentations.

My seminar on the final day of the conference was based on my research with over 40 adult survivors of organized sexual abuse, and 20 mental health professionals who specialize in their care. I focused on the circumstances in which organized abuse takes place, the types of maltreatment that victims are subjected to, and the challenges and opportunities that organized abuse poses to law enforcement. In particular, I emphasized the considerable expertise on organized abuse held by specialist mental health practitioners. While there are specialists in organized abuse in policing and mental health, there has been limited exchange between these two groups. I also flagged the need for a therapeutically informed style of policing and prosecution of serious child sex offences, since rigid or inappropriate criminal justice processes are frequently intolerable or revictimising for adults or children with a dissociative disorder.

Increased law enforcement awareness of child abuse material, due to its ubiquity on the internet, has in many ways validated the long-standing work of clinicians in the trauma and dissociative disorders fields. Online child abuse material provides incontrovertible evidence for those forms of abuse and exploitation that severely victimized children and adults have been disclosing for decades. While the online distribution of this material needs to be investigated and prosecuted as a serious offence, it is symptomatic of the broader, and as yet, inadequately addressed problem of abuse and exploitation. I left the conference with a clearer vision of the work that still needs to be done in addressing ‘offline’ as well as ‘online’ child sexual exploitation, in high income countries such as my own as well as in the developing world.

Responding to recent reporting on "false memories"

The Australian newspaper has run a series of articles over the last few months questioning the credibility of adults who allege sexual abuse in childhood. These articles have been based on misinformed beliefs about the science of trauma and memory. With two colleagues, I authored a response piece that was published in the weekend edition of the paper.

Reporting Revives Bad Memories of Contentious Theories
Warwick Middleton, Martin Dorahy & Michael Salter
The Weekend Australian, 14-15 October 2017, p.22.

Recent reporting by Richard Guilliatt has raised questions about the credibility of adults reporting child sexual abuse (`Those Events Never Happened', The Weekend Australian Magazine, October 4-5). Underlying these articles has been a sense of unease or outrage about the accuracy of memories of severe abuse being retrieved after a period of being forgotten by some traumatized individuals.

Reading these articles, there is the feeling that we have stepped back into the previous century, before science had a solid understanding of the effects of trauma on memory. The early-to-mid 1990s saw the creation of terms like ‘recovered memory therapy’ to characterize mental health care for sexually abused people as stirring up false memories of traumatic events.

Activists promoting this view lobbied the Victorian Health Minister of the time, Bronwyn Pike, into launching an inquiry examining the extent "recovered memory therapy” was practiced in Victoria. The inquiry reported in 2005, finding that the term was not used by health professionals but was being used by lobby groups for political purposes.

In the more than two decades that have passed since activists first coined the term “recovered memory therapy”, the link between trauma and amnesia has been settled by science. Amnesia for trauma occurs across the spectrum – from soldiers participating in combat, to disaster survivors, to those who kill in “crimes of passion”, to the victims of child abuse.

While memories of trauma can return in therapy, they are more likely to arise in other situations. Chance encounters with people from one’s past, or watching movies or television programs, can trigger the emergence of what were previously inaccessible memories of abuse. Generally, recovered memories of trauma are about as accurate as memories that have been held continually. Both are thus equivalently inaccurate.

Revisiting old controversies about “recovered memories” risks obscuring what the Royal Commission into Institutional Responses to Child Sexual abuse has established beyond doubt. Multiple institutions provided the necessary conditions for child sexual abuse to occur, with negligible likelihood that anyone in authority would take decisive action to protect children. Amnesia has been a common way for victims of institutional abuse to cope with such traumatic experiences.

On February 22, Australians witnessed an unusual event. Five Catholic bishops (one facing charges of failing to report child abuse allegations) representing the Australian-based institution associated with the sexual abuses of more children than any other, attended the Royal Commission to reflect on their collective failure. Bishop Anthony Fisher put it succinctly; “It was a kind of criminal negligence to [not] deal with some of the problems that were staring us in the face.”

A documented case from the royal commission poignantly demonstrates the phenomena of abuse-related amnesia. Philippe Vincent Trutmann, who was sentenced to 6 1/2 years in prison in 2005, confessed to sexually abusing Geelong Grammar student Luke Benson 30 to 40 times over a two-year period. Mr Benson had been asked to attend Prahran police station in 2005. But Mr. Benson, who remembers Trutmann as a “father figure,” testified that he has no recollection of the abuse despite being diagnosed with post-traumatic stress disorder. Ross Cheit of Brown University in the US maintains a substantial website archiving corroborated cases of individuals who have recovered such memories.

Revelations about the sexual offences of entertainers such as Gary Glitter, Jimmy Savile and Robert Hughes show offenders often hide behind a cover of respected celebrity. Recent examples of prominent trusted Australian individuals being convicted of child sex crimes include child psychiatrist Dr Aaron Voon, IVF geneticist Michael Quin and singer, Rolf Harris. Personable South Australian child welfare worker, Shannon McCoole led a breath-taking double life as the head administrator of the world’s biggest paedophile network, a 45,403-member website.

Child sexual abuse is pervasive and unsettling. Abuse is a frequent cause of harm, but individual offences are often difficult to prove to a criminal standard. One resolution to this ambiguity is to hold the victim, not the offender, responsible. Social psychologists have studied for many years the tendency within human beings to blame the victims, question their motives, or attack their credibility. Here we deny the data, or reinterpret it, and denigrate or blame the victim to reduce the discomfort caused by facing the reality that innocent people are intentionally hurt by others.

A recent large-scale review by psychology professors Chris Brewin and Bernice Andrews of the studies exploring the creation of false memories in research laboratory settings concluded that the creation of false memories of childhood events has been exaggerated. Interestingly, the authors were attacked in commentaries that misrepresented their ideas and made erroneous claims about their review. Scientific data does not support the proposition that false memories of child sexual abuse can be routinely and easily created. However, this belief has become an item of faith for those unable, or unwilling, to face the uncomfortable reality of adult cruelty to children.

We still have much to learn about child abuse, trauma and memory. Excellent clinical guidelines for the treatment of complex trauma have been published by the Blue Knot Foundation, which are cited internationally as best practice. However, the evidence base remains incomplete. How sexual abuse interferes with memory, and the most effective ways of treating victims of child abuse, are the subjects of ongoing research around the world.

In the meantime, the media is a vital partner in the distribution of accurate information about child abuse and promoting child wellbeing and safety.

Reanimating settled controversies from the 1990s sows doubt where there is comprehension, and fails to keep pace with vital developments in the field. At worst, it risks promoting misinformation that compromises children’s safety and it blights the lives of survivors of child abuse.

Dissociative Identity Disorder exists and it is the result of childhood trauma

In response to a resurgence of "false memory" reporting in Australia, I worked with clinical colleagues Warwick Middleton and Martin Dorahy to write this explanatory piece on Dissociative Identity Disorder for The Conversation.

Once known as multiple personality disorder, dissociative identity disorder remains one of the most intriguing but poorly understood mental illnesses. Research and clinical experience indicate people diagnosed with the condition have been victims of sexual abuse or other forms of criminal mistreatment.

But a vocal group of academics and health professionals have claimed dissociative identity disorder, and reports of trauma associated with it, are created by therapists and the media. They say these don’t reflect genuine symptoms or accurate memories.

Media references to dissociative identity disorder are also often highly stigmatising. The recent movie Split depicted a person with the condition as a psychopathic murderer. Even supposedly factual reporting can present people with dissociative identity disorder as untrustworthy and prone to wild fantasies and false memories.

But research hasn’t found people with the disorder are more prone to “false memories” than others. And brain imaging studies show significant differences in brain activity between people with dissociative identity disorder and other groups, including those who have been trained to mimic the disorder.

What is it?

Dissociative identity disorder has been studied by doctors and scientists for well over 100 years. In 1980, it was called multiple personality disorder in the Diagnostic and Statistical Manual of Mental Disorders(DSM), which outlines the symptoms of psychiatric conditions. Its name was changed in the 1994 edition of the DSM.

Dissociative identity disorder comes about when a child’s psychological development is disrupted by early repetitive trauma that prevents the normal processes of consolidating a core sense of identity. Reports of childhood trauma in people with dissociative identity disorder (that have been substantiated) include burning, mutilation and exploitation. Sexual abuse is also routinely reported, alongside emotional abuse and neglect.

In response to overwhelming trauma, the child develops multiple, often conflicting, states or identities. These mirror the radical contradictions in their early attachments and social and family environments – for instance, a parent who swings unpredictably between aggression and care.

According to the DSM-5, the major characteristic of dissociative identity disorder is a disruption of identity, in which a person experiences two or more distinct personality states (or, in other cultures, experiences of so-called possession).

These states display marked differences in a person’s behaviour, recollections and opinions, and ways of engaging with the world and other people. The person frequently experiences gaps in memory or difficulties recalling events that occurred while they were in other personality states.

The manifestations of these symptoms are subtle and well concealed for most patients. However, overt symptoms tend to surface during times of stress, re-traumatisation or loss.

Media references to dissociative identity disorder, like the lead character in the movie Split, are often highly stigmatising.

People with the condition typically have a number of other problems. These include depression, self-harm, anxiety, suicidal thoughts, and increased susceptibility to physical illness. They frequently have difficulties engaging in daily life, including employment and interactions with family.

This is, perhaps, unsurprising, given people with dissociative identity disorder have experienced more trauma than any other group of patients with psychiatric difficulties.

Dissociative identity disorder is a relatively common psychiatric disorder. Research in multiple countries has found it occurs in around 1% of the general population, and in up to one fifth of patients in inpatient and outpatient treatment programs.

Trauma and dissociation

The link between severe early trauma and dissociative identity has been controversial. Some clinicians have proposed dissociative identity disorder is the result of fantasy and suggestibility rather than abuse and trauma. But the causal relationship between trauma and dissociation(alterations of identity and memory) has been repeatedly shown in a range of studies using different methodologies across cultures.

People with dissociative identity disorder are generally unresponsive to (and may deteriorate under) standard treatment. This may include cognitive behavioural treatment, or exposure therapy for post-traumatic stress disorder.

Phase-orientated treatment has been shown to improve dissociative identity disorder. This involves stages (or phases) of treatment, from an initial focus on safety and stabilisation, through to containment and processing of trauma memories and feelings, to the final phase of integration and rehabilitation. The goal of treatment is for the person to move towards better engaging in life without debilitating symptoms.

An international study that followed 280 patients with dissociative identity disorder (or a variant of it, which is a dissociative disorder not otherwise specified) and 292 therapists over time, found this approach was associated with improvements across a number of psychological and social functioning areas. Patients and therapists reported reduction in dissociation, general distress, depression, self-harm and suicidal thoughts.

Controversies and debates

Critics have pointed to poor therapeutic practice causing dissociative symptoms as well as false memories and false allegations of abuse. Some are particularly concerned therapists are focused on recovering memories, or encouraging patients to speculate that they have been abused.

However, a contemporary survey of clinical practice among specialists of dissociative identity found those treating the disorder weren’t focused on retrieving memories at any phase of the treatment.

A recent literature analysis concluded that criticisms of dissociative identity disorder treatment are based on inaccurate assumptions about clinical practice, misunderstandings of symptoms, and an over-reliance on anecdotes and unfounded claims.

Dissociative identity disorder treatment is frequently unavailable in the public health system. This means people with the condition remain at high risk of ongoing illness, disability and re-victimisation.

The underlying cause of the disorder, which is severe trauma, has been largely overlooked, with little discussion of the prevention or early identification of extreme abuse. Future research should not only address treatment outcomes, but also focus on public policy around prevention and detection of extreme trauma.

The continuum of control strategies in organised abuse

Control is one of the central dynamics of organised abuse. Psychologically, perpetrators are often motivated to sexually abuse children by a desire to feel powerful, and displaying control over their victim/s accomplishes this. From a practical point of view, maintaining this control is crucial to ensuring that organised abuse goes undetected. 

In this sense, organised abuse is similar to (and often intersects with) other forms of gender-based violence such as domestic violence, which is also characterised by the use of physical and sexual violence to control and dominate victims. 

However, while the control strategies of domestic violence perpetrators are well documented (although they continue to evolve), the ways in which organised abuse perpetrators control their victims has received considerably less attention.

Over the last twelve months, I've been developing a continuum of control strategies in organised abuse to articulate the degrees of control that abusive groups exert over their victims. The continuum is provided below:

Level 0: Chaotic, disorganised abuse

Mass child abuse occurs due to social disorganisation, such as a breakdown in the social fabric due to factors including cumulative disadvantage, mental illness, intergenerational trauma and geographic/social isolation.

Level 1: Opportunistic or situational organised abuse

Organised abuse occurs due to the convergence of multiple motivated offenders, vulnerable children and a lack of oversight or consequence.

Level 2: Motivated and premeditated organised abuse

Perpetrator groups have a well-developed repertoire of grooming and inducement tactics designed to manipulate and entrap their victims in a culture of abuse and exploitation. Coerced perpetration often begins at this level, in which the child is manipulated or forced into the abuse of other children to engender a sense of complicity and shame.

Level 3: Coercive control in organised abuse

Perpetrators seek control over all aspects of the child’s life, including the child’s body and sexuality, and exchange the child with other perpetrators to demonstrate their ‘ownership’ of the child.

Level 4: Disruption of recall and disclosure

Perpetrator groups use methods such as sedation, drugging and hypnosis to disrupt victim memory and limit their ability to disclose abuse. These strategies result in significant gaps in victim memory, including a partial or total lack of recall for abuse.

Level 5: Deliberate traumatisation

Perpetrator groups orchestrate traumatic ordeals with the intention of terrorising victims, inducing traumatic symptoms such as amnesia and severing the child’s sense of belonging to the social order.

Level 6: Induction and manipulation of dissociation

Perpetrator groups use electroshock, ritual abuse and other forms of torture with the intention of creating dissociative parts, systems and responses.

As the continuum progresses, the likelihood of detection, investigation and prosecution diminishes. Levels one and two describe those cases of organised abuse that are most likely to come to the attention of the authorities. Level three is being occasionally prosecuted, however level four, involving the use of sedatives and other measures to interfere with victim memory and disclosure, is the point beyond which criminal justice sanction rarely occurs.

Levels five and six describe the most destructive and effective control strategies utilised by organised abuse perpetrators. These tactics virtually ensure the impunity of organised abuse perpetrators, since they profoundly compromise the ability of victims to protect themselves or seek help. Most victims subject to these techniques will never disclose, and those that do are likely to be disbelieved or labeled as delusional. 

The full continuum of these control tactics has been well documented by mental health practitioners working with organised abuse victims and survivors for over thirty years. However, the breadth of this continuum is largely unknown to law enforcement, child protection services and most mental health practitioners and agencies.

There is a clear need for comprehensive training in the control tactics of perpetrator groups to ensure that organised abuse is being adequately investigated, disrupted and prosecuted, and victims and survivors are being identified and supported.