Opening up about sexual abuse: the challenges, fears, and how to heal

The #Metoo movement, and the courage of survivors speaking out about their abuse around the world, show signs of a growing awareness and acknowledgment of the scale of sexual abuse. Equally strong are the voices of those who seek to deny this reality and blame victims (often, though not always, younger women) for lying, or having in some way caused the abuse.  

The arguments are familiar: “but that was years ago - why didn’t she say something at the time?”; “There are so many holes in her story...she must be lying.”; “She was dressed provocatively / drunk.."; "...but he’s an upright family man / he gives to charity / he’s a judge - he can’t possibly have done this....” 

We hear these arguments from ordinary people, journalists, politicians, celebrities...denial is widespread throughout society.

What is often missed is that, when someone has been sexually assaulted, raped or abused, there are powerful psychological factors preventing them from talking about it, even with a person who is sympathetic. I will explore these reasons to show that a psychotherapist would think very differently about a client’s silence, seeing it as a sign they had been badly traumatised. I'll also explain how EMDR therapy can help someone recover from what cannot be expressed. 

The position of power - a starting point for abuse

The first factor which prevents victims speaking out about their abuse is power: abuse, (physical, emotional or sexual) happens for many reasons, but the common factor is that one person is in a position of power over another, and exploits that to take advantage of the other. Recent cases have included politicians, Hollywood film producers, really well-connected celebrities, football coaches etc. In less-high-profile cases it’s been teachers, parents, priests, social workers...the theme is that the abuser has influence over the victim, and uses this influence to groom, manipulate and exploit in preparation for the abuse - and to silence them afterwards. The victim is left feeling helpless, isolated and afraid of retribution - intimidated into silence.

The brain's chemical responses to abuse, and how this can make things worse

What happens in the brain during and after a traumatic incident like a sexual assault, rape or abuse, can make the situation worse.

In any dangerous situation, information about threat or danger is sent to a part of the brain called the Amygdala - what Bessel Van Der Kolk (2014) calls the brain’s “smoke detector”. The smoke detector looks at the information and decides if there really is a threat, and how to respond if so: to fight it, run away or curl up and hope it goes away - or fight, flight or freeze. It sends signals to the lungs, heart, other organs, arms and legs, to get them ready to respond accordingly. It does this in a flash, before the conscious brain even knows there is a threat, and you can find yourself running or frozen before you know what is happening.

This is important to remember if you feel guilty for not fighting back, for running (or for not running), or for freezing: the decision was already taken, so you don’t need to feel responsible. You might also have been prevented from running away because you were trapped by the abuser, either physically or through use of the power they had over you. And this is another part of the problem.

The signals the smoke detector send out are called stress hormones and contain chemicals such as adrenaline and cortisol. These are really helpful in the moment as they give the strength to fight or run, to save yourself; however, if they stay too long in your system, they can cause lasting problems.

If the Amygdala perceives a threat and sends out signals to get you to run away, the energy of the stress hormones is burned off as you run. You reach a place of safety, the brain realises the danger is over and calms itself and the body down. The memory of the incident would then be moved moved to the brain’s library: the hippocampus.

The hippocampus is “the back of your mind”; usually, if you have an unpleasant experience, you relax afterwards and find the next day that you have forgotten about it. The brain has processed the memory overnight, taken the emotional heat out of it, and stored it in the hippocampus / library. If you want, you can take it out and look at it, but you know that what happened happened in the past - it's over, and isn’t happening again. This is because the library can tell the difference between when the incident happened and now, when you are remembering it. 

During a trauma - especially where you couldn’t get away - there is too much information for the brain to take in at one time, so it can’t be moved into the hippocampus / library. There is too much information for it to get through the door of the library and it gets stuck in the Amygdala / smoke detector, which has no sense of time or place. If something happens to remind it of the original incident, the smoke detector thinks it’s happening again. 

This is what happens when a survivor of abuse is “triggered”. They feel the same sensations (fear, pain, sweating, increased heart rate) and often see the same images and smell the same smells. In short, you think it’s happening all over again. This is so much worse if you couldn’t get away at the time of the assault, as the original stress hormones are still surging round your body keeping you alert, on edge, fearing you will be attacked again, or that the incident is still going on. 

The Amygdala / smoke detector is also in the non-verbal part of the brain. Any memory stored there is not stored as language; it’s mostly stored as physical or emotional sensations - the pain, fear, sweating you might feel when reminded of the incident. You might see fragments of images, but it will be really confusing and hard to piece together or really explain to someone what happened. A lawyer, police officer or journalist might want a clear, linear account (this happened, then this), but if the assault is recorded in this non-verbal area of the brain, it can be nearly impossible to give a clear account - another powerful factor in explaining why some survivors of serious assaults and abuse (especially those taking place multiple times over many years) find it so difficult to speak up. 

The emotional abuse, the put-downs, the criticism, the sarcasm (which so often accompanies sexual and physical abuse) undermine the survivor’s self-confidence, esteem and trust in other people, making it all the more difficult to tell the story. 

The dual role of counselling and EMDR in healing from abuse

Spending time with a talking therapist can help you piece together a narrative, process difficult memories and gain relief from symptoms, but if the memory which is bothering you is buried deep within the non-verbal brain, then there will be aspects of it which talking cannot reach.

EMDR (Eye Movement Desensitisation and Reprocessing (Shapiro, F, 2001), is a Therapy built on the model of the brain during trauma described above. It uses eye movements and other forms of directing your attention from left to right to stimulate natural healing mechanisms within the brain. By by-passing language and working directly with the brain, it can reach and relieve memories held in non-verbal areas and in the body. 

Rather than asking you to recount a difficult memory in detail, the therapist will ask you to hold in mind a particular image from it; the negative thoughts you have about yourself when you think about it, the emotions you feel and where you feel them in the body. Together, you will identify a positive thought about yourself that you would like to feel in relation to the incident, and the therapist will ask you to follow their fingers with your eyes, moving them from left to right and back again for about twenty to thirty seconds. They will stop and ask you what you see and feel in that moment, before starting again. 

Gradually, or sometimes rapidly, the image will start to change; you will remember other aspects of the event and jump to other memories. You may feel powerful emotions and physical sensations, but your therapist will remind you that this is just old material leaving your brain as it is flushed out by the processing. 

The therapist will check how much emotion you feel and how strong the positive belief feels. Once the belief feels completely true and the emotion has gone from the memory, it will have passed from the smoke detector to the library, and be something you can remember without being overwhelmed.

Being believed when you tell someone you were abused, can be incredibly powerful and working through the memories therapeutically can help you on the road to healing.

References:

- Shapiro, F. 2001. Eye Movement Desensitisation & Reprocessing: Basic Principles, Protocols & Procedures. Guildford Press. New York.

- Van Der Kolk, B. 2014. The Body Keeps the Score. Penguin. London.