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8 June, 2015

On the off chance that someone may wonder where the material came from for the posts about PTSD in survivors, the following is the story.  It’s been said that, from an intrapsychic standpoint, people who get into studying and doing counseling are actually seeking to cure themselves.  It can be added that, from a family systems perspective, they are seeking to cure their families.  Both may be true because we carry our families within, and curing at least the inner family cures the self.


When I was in graduate school, I had one opportunity in two years to take an elective course.  Schools of social work are sanctioned by the National Council on Social Work Education which requires any university offering degrees in social work to ensure core curricula are largely consistent no matter where one attends school.  It’s more than a bit unique to have a nationally standardized curriculum in any discipline and it was a surprising opportunity that I could squeeze in an elective. The course catalog offered one entitled The Biological Bases of Behavior.  While my interest was largely in intrapsychic phenomena, I thought I probably should learn something about what the course suggested would be the content.

It turned out to be quite different from what I was expecting.  For one solid semester, we studied the process and uses of mental status examinations, differential diagnosis, and just a twitch about the use of medications in treatment (the sole ‘biological’ element in the course). I was enthralled, fascinated and generally jazzed by mental status examinations and their capacity to get at deep, intrapsychic processes and symptoms.  ( I was impressed with the M.D. instructor, who addressed the tendency of doctors to overestimate what they knew, saying “M.D.” stood for “Me Deity”.)

I went on study mental status examinations further on my own, doing such obsessive things as reading an entire psychiatric dictionary (Hinsey and Campbell) cover to cover to help me know what to look for and what to call what I might find.  Over time, I developed some tactics and techniques of my own for performing such examinations. Serendipity had primed me to notice things no one who had researched and written about sexual abuse survivors had ever touched on other than nonspecific generalities, such as the fact that survivors have nightmares and low self esteem.  What had been missed was the collection of specific, shared symptoms which were astonishingly similar and consistent across class, culture and even nationality. Susan Forward went so far as to say that the only thing survivors had in common was their history of child abuse. She was a an expert, but very, very wrong.


My first job after graduate school (I had been in public social services up to then) was in a mental health clinic. Not terribly long after I started there, I saw a woman who had been mandated to seek treatment by Child Protective Services in connection with the abuse of her children by her male partner. I was, of course, doing fairly thorough mental status examinations as a part of my intake evaluations of new clients and noted some symptoms which, at the time, appeared to have some logical connection to her situation. From her I learned a few things. I thought I might be onto something that had to do with risk factors for abusing children or associating with abusers.  I was barely even warm.

I should interject that a colleague had talked excitedly about an upcoming conference at which Susan Forward, whose book Betrayal of Innocence had come out about the time I graduated, was going to speak.  My colleague said it was all about the sexual abuse of children – would I be interested. I said no. I couldn’t see that particular issue as being something in which I’d be especially interested.

What I did do was request that any new clients seeking treatment at the clinic who had been referred due to any child abuse issues be assigned to me for their initial evaluations so that I could see if I was on to something. Was I ever, even though I was at best lukewarm initially. In those interviews I probed deeper and developed techniques to get at things I had no way of knowing might exist in addition to what I did know might exist.  Along the way, the collection of symptoms was getting fleshed out so clearly and consistently that I could (for myself, at least) comfortably call the patterns a syndrome.


I began to incorporate what I had learned into my usual mental status examinations with other female clients. What I found was that many other women who had no child abuse-associated problems or complaints had the same syndrome. Out the window went the vague hypothesis about child abuse proclivities in behavior or partner choices. Sneaking in the back door was their common history of childhood sexual abuse.  I now knew what it was all about and gobbled up mental status information like turkey and dressing at Thanksgiving. Even though I had blown off the Susan Forward thing, I knew enough about the sequelae of childhood abuse to know I had made a unique discovery; so unique, in fact, that I knew I would eventually publish what I had found in a major, refereed social work journal. (In refereed reviews, the reviewers do not know who the author is, eliminating the possibility that only known experts would be published.)

I had reason, not terribly later on, to consider blowing off the Susan Forward presentation as very likely being a defense mechanism.  (In one session of my own personal therapy, talking about something that had nothing to do with my topic here, my therapist suggested something to me that might be a factor in what I was talking about at the moment.  I protested that the suggestion had absolutely nothing to do with anything, period — and promptly dissociated into a depersonalized state.)

Being cursed with a fairly good and active capacity for introspection I began to challenge myself.  Sure – this stuff was absolutely fascinating from a clinical perspective; Sure, it was a somewhat momentous discovery; but exactly why was I so obsessed with it?


One of the symptoms I had noted, though it may not quite properly be classified as an intrapsychic symptom, was migraine headaches.  My mother suffered terribly from them. I was aware that other symptoms, which I call associated symptoms, existed around the family.  Those ‘associated’ symptoms were what Susan Forward and many others spoke of: Depression, anxiety, relationship problems, poor self-esteem, etc.  Because lots of people suffer with those problems that have no history of abuse, it was correctly thought that such problems were not flashing red lights when it came to sexual abuse, though they were a focus of treatment for sexual abuse survivors and were what drove them into such therapy.

In a matter of months after the publishing of my first paper on the syndrome, my father committed suicide. In the wake of that, my mother invited me to take her on a drive into the mountains to a park for a picnic and talk. (I finally feel comfortable with this revelation since she passed away some years ago.)  Once there, we sat on a picnic bench and she told me of her rape by a cousin at age six.  She spoke of how, had she sought some kind of treatment, her relationship with my father (from whom she had been divorced since I was 14), and our very lives may have been very different. Though I had harbored my suspicions, I did not solicit the information, but it was as if converging lines of my life, my career, my understanding of my family and a host of other things finally came to a single point and exploded into a circle that encompassed it all.

She spoke as well of family suspicions that my father had been molested by a Scout leader, and her suspicion that his mother (my grandmother) herself may have been, at the very least, inappropriate with him.  I have probed deeply enough into myself symptomatically, affectively and intellectually to be reasonably certain that I was not victimized as a child. However, the victimized were a part of the family within me, and that colored my life in countless ways, not the least of which was being led down a trail of discovery that ran from a community mental health clinic, out into the larger world in a meandering circle and right back to the heart of my own family.

Out of respect, I cannot speak of other family members other than to say I’ve had several suspicions and not a little corroboration of those suspicions. So here is the blog, the syndrome, my concern for my figurative sisters, my anger at the psychiatric establishment for name-calling, and, if I may please be forgiven, my tiny bit of pride and satisfaction about having been able to help things along at least a little.

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