Child Psychiatry Quotes

It is a rare person who can cut himself off from mediate and immediate relations with others for long spaces of time without undergoing a deterioration in personality.

There is no group therapy or psychiatry or community social services for the child who must cope with the thing under the bed or in the cellar every night, the thing which leers and capers and threatens just beyond the point where vision will reach. The same lonely battle must be fought night after night and the only cure is the eventual ossification of the imaginary faculties, and this is called adulthood.

The young and the old are defenseless against relatives who want to get rid of them by casting them in the role of mental patient,and against psychiatrists whose livelihood depends on defining them as mentally ill.

Before drifting away entirely, he found himself reflecting---not for the first time---on the peculiarity of adults. Thet took laxatives, liquor, or sleeping pills to drive away their terrors so that sleep would come, and their terrors were so tame and domestic: the job, the money, what the teacher will think if I can't get Jennie nicer clothes, does my wife still love me, who are my friends. They were pallid compared to the fears every child lies cheek and jowl with in his dark bed, with no one to confess to in hope of perfect understanding but another child. There is no group therapy or psychiatry or community social services for the child who must cope with the thing under the bed or in the cellar every night, the thing which leers and capers and threatens just beyond the point where vision will reach. The same lonely battle must be fought night after night and the only cure is the eventual ossification of the imaginary faculties, and this is called adulthood.

The mental health system is filled with survivors of prolonged, repeated childhood trauma. This is true even though most people who have been abused in childhood never come to psychiatric attention. To the extent that these people recover, they do so on their own.[21] While only a small minority of survivors, usually those with the most severe abuse histories, eventually become psychiatric patients, many or even most psychiatric patients are survivors of childhood abuse.[22] The data on this point are beyond contention. On careful questioning, 50-60 percent of psychiatric inpatients and 40-60 percent of outpatients report childhood histories of physical or sexual abuse or both.[23] In one study of psychiatric emergency room patients, 70 percent had abuse histories.[24] Thus abuse in childhood appears to be one of the main factors that lead a person to seek psychiatric treatment as an adult.[25]

As recently as 1975, a basic American psychiatry textbook estimated that the frequency of all forms of incest as one case per million. [James Henderson, "Incest", in A. M. Freedman, H.I. Kaplan and B.J. Sadock, eds., Comprehensive Textbook of Psychiatry, 2nd ed. 1975 p. 1532.]

A refusal on the part of psychiatrists and therapists to validate the horrors of their patients' tortured past implies a refusal to take seriously the unconscious psychological mechanisms that individuals need to use to protect themselves from the unspeakable. Such a denial is, however, no longer ethical, for it is in the human capacity to dissociate that lies part of the secret of both childhood abuse and the horrors of the Nazi genocide, both forms of human violence so often carried out by 'respectable' men and women.

Sadly, psychiatric training still includes far too little on the very serious psychiatric sequelae of childhood trauma, especially CSA [child sexual abuse]. There is inadequate recognition within mental health services of the prevalence and importance of Dissociative Disorders, sufferers of which are frequently misdiagnosed as Borderline Personality Disorder (BPD), or, in the cases of DID, schizophrenia. This is to some extent understandable as some of the features of DID appear superficially to mimic those of schizophrenia and/or Borderline Personality Disorder.

It was Freud's ambition to discover the cause of hysteria, the archetypal female neurosis of his time. In his early investigations, he gained the trust and confidence of many women, who revealed their troubles to him.Time after time, Freud's patients, women from prosperous, conventional families, unburdened painful memories of childhood sexual encounters with men they had trusted: family friends, relatives, and fathers. Freud initially believed his patients and recognized the significance of their confessions. In 1896, with the publication of two works, The Aetiology of Hysteria and Studies on Hysteria, he announced that he had solved the mystery of the female neurosis. At the origin of every case of hysteria, Freud asserted, was a childhood sexual trauma. But Freud was never comfortable with this discovery, because of what it implied about the behavior of respectable family men. If his patients' reports were true, incest was not a rare abuse, confined to the poor and the mentally defective, but was endemic to the patriarchal family. Recognizing the implicit challenge to patriarchal values, Freud refused to identify fathers publicly as sexual aggressors. Though in his private correspondence he cited "seduction by the father" as the "essential point" in hysteria, he was never able to bring himself to make this statement in public. Scrupulously honest and courageous in other respects, Freud falsified his incest cases. In The Aetiology of Hysteria, Freud implausibly identified governessss, nurses, maids, and children of both sexes as the offenders. In Studies in Hysteria, he managed to name an uncle as the seducer in two cases. Many years later, Freud acknowledged that the "uncles" who had molested Rosaslia and Katharina were in fact their fathers. Though he had shown little reluctance to shock prudish sensibilities in other matters, Freud claimed that "discretion" had led him to suppress this essential information. Even though Freud had gone to such lengths to avoid publicly inculpating fathers, he remained so distressed by his seduction theory that within a year he repudiated it entirely. He concluded that his patients' numerous reports of sexual abuse were untrue. This conclusion was based not on any new evidence from patients, but rather on Freud's own growing unwillingness to believe that licentious behavior on the part of fathers could be so widespread. His correspondence of the period revealed that he was particularly troubled by awareness of his own incestuous wishes toward his daughter, and by suspicions of his father, who had died recently. p9-10

What daily life is like for “a multiple” Imagine that you have periods of “lost time.” You may find writings or drawings which you must have done, but do not remember producing. Perhaps you find child-sized clothing or toys in your home but have no children. You might also hear voices or babies crying in your head. Imagine that you can never predict when you will be able to have certain knowledge or social skills, and your emotions and your energy level seem to change at the drop of a hat, and for no apparent reason. You cannot understand why you feel what you feel, and, if you are in therapy, you cannot explore those feelings when asked. Your life feels disjointed and often confusing. It is a frightening experience. It feels out of control, and you probably think you are going crazy. That is what it is like to be multiple, and all of it is experienced by the ANPs. A multiple may also experience very concrete problems, even life-threatening ones.

Dissociation is the ultimate form of human response to chronic developmental stress, because patients with dissociative disorders report the highest frequency of childhood abuse and/or neglect among all psychiatric disorders. The cardinal feature of dissociation is a disruption in one or more mental functions. Dissociative amnesia, depersonalization, derealization, identity confusion, and identity alterations are core phenomena of dissociative psychopathology which constitute a single dimension characterized by a spectrum of severity. Clinical Psychopharmacology and Neuroscience 2014 Dec; 12(3): 171-179 The Many Faces of Dissociation: Opportunities for Innovative Research in Psychiatry

It is acknowledged that father-daughter incest occurs on a large scale in the United States. Sexual abuse has now been included in child abuse legislation. A conservative estimate is that more than 1 million women have been sexually victimized by their fathers or other male relatives, but the true figure probably is much higher. Many victims still fear reporting incest, and families continued to collude to keep the situation secret. Issues of family privacy and autonomy remain troublesome even when incest is reported and must be resolved for treatment to be effective. " Mary de Chesnay J. Psychosoc. Nurs. Med. Health Sep. 22:9-16 Sept 1984 reprinted in Talbott's 1986 edition

Advances in biological knowledge have highlighted the potential chronicity of effects of childhood maltreatment, demonstrating particular life challenges in managing emotions, forming and maintaining healthy relationships, healthy coping, and holding a positive outlook of oneself.

Standing on the edge with my patients — abiding with them — means that I must harbor a true awareness that I, too, could lose my child through the play of circumstance over which I have no control. I could lose my home, my financial security, my safety. I could lose my mind. Any of us could.

SELFHOOD AND DISSOCIATION The patient with DID or dissociative disorder not otherwise specified (DDNOS) has used their capacity to psychologically remove themselves from repetitive and inescapable traumas in order to survive that which could easily lead to suicide or psychosis, and in order to eke some growth in what is an unsafe, frequently contradictory and emotionally barren environment. For a child dependent on a caregiver who also abuses her, the only way to maintain the attachment is to block information about the abuse from the mental mechanisms that control attachment and attachment behaviour.10 Thus, childhood abuse is more likely to be forgotten or otherwise made inaccessible if the abuse is perpetuated by a parent or other trusted caregiver. In the dissociative individual, ‘there is no uniting self which can remember to forget’. Rather than use repression to avoid traumatizing memories, he/she resorts to alterations in the self ‘as a central and coherent organization of experience. . . DID involves not just an alteration in content but, crucially, a change in the very structure of consciousness and the self’ (p. 187).29 There may be multiple representations of the self and of others. Middleton, Warwick. "Owning the past, claiming the present: perspectives on the treatment of dissociative patients." Australasian Psychiatry 13.1 (2005): 40-49.

Someone asked me recently, what it is like to live with OCD. I paused for a while and said, imagine watching your sibling getting run over by a truck in front of your eyes, not once, not twice, but repeatedly like in a looped video, or your child getting beaten up at school, or your partner getting abused by strangers on the street - and the only way you can stop that event from happening is to keep on repeating the task that you were carrying out when the vision first appeared in your mind, until some other less emotionally agonizing thought breaks the loop of that particular vision and replaces it - and though you know, it's just a thought and not the destiny of the people you love, you feel it excruciatingly necessary to keep repeating the task until the thought passes, so that nothing bad happens to your loved ones - and that's what it is like inside the head of a person with OCD, every moment of their life.

That question became even more salient to me as I began my clinical work with troubled children. I soon found that the vast majority of my patients had lives filled with chaos, neglect and/or violence. Clearly, these children weren’t “bouncing back”—otherwise they wouldn’t have been taken to a child psychiatry clinic! They’d suffered trauma—such as being raped or witnessing murder—that would have had most psychiatrists considering the diagnosis of post-traumatic stress disorder (PTSD), had they been adults with psychiatric problems. And yet these children were being treated as though their histories of trauma were irrelevant, and they’d “coincidentally” developed symptoms, such as depression or attention problems, that often required medication.

Environmental influences also affect dopamine. From animal studies, we know that social stimulation is necessary for the growth of the nerve endings that release dopamine and for the growth of receptors that dopamine needs to bind to in order to do its work. In four-month-old monkeys, major alterations of dopamine and other neurotransmitter systems were found after only six days of separation from their mothers. “In these experiments,” writes Steven Dubovsky, Professor of Psychiatry and Medicine at the University of Colorado, “loss of an important attachment appears to lead to less of an important neurotransmitter in the brain. Once these circuits stop functioning normally, it becomes more and more difficult to activate the mind.” A neuroscientific study published in 1998 showed that adult rats whose mothers had given them more licking, grooming and other physical-emotional contact during infancy had more efficient brain circuitry for reducing anxiety, as well as more receptors on nerve cells for the brain’s own natural tranquilizing chemicals. In other words, early interactions with the mother shaped the adult rat’s neurophysiological capacity to respond to stress. In another study, newborn animals reared in isolation had reduced dopamine activity in their prefrontal cortex — but not in other areas of the brain. That is, emotional stress particularly affects the chemistry of the prefrontal cortex, the center for selective attention, motivation and self-regulation. Given the relative complexity of human emotional interactions, the influence of the infant-parent relationship on human neurochemistry is bound to be even stronger. In the human infant, the growth of dopamine-rich nerve terminals and the development of dopamine receptors is stimulated by chemicals released in the brain during the experience of joy, the ecstatic joy that comes from the perfectly attuned mother-child mutual gaze interaction. Happy interactions between mother and infant generate motivation and arousal by activating cells in the midbrain that release endorphins, thereby inducing in the infant a joyful, exhilarated state. They also trigger the release of dopamine. Both endorphins and dopamine promote the development of new connections in the prefrontal cortex. Dopamine released from the midbrain also triggers the growth of nerve cells and blood vessels in the right prefrontal cortex and promotes the growth of dopamine receptors. A relative scarcity of such receptors and blood supply is thought to be one of the major physiological dimensions of ADD. The letters ADD may equally well stand for Attunement Deficit Disorder.

Some alters are what Dr Ross describes in Multiple Personality Disorder as 'fragments'. which are 'relatively limited psychic states that express only one feeling, hold one memory, or carry out a limited task in the person's life. A fragment might be a frightened child who holds the memory of one particular abuse incident.' In complex multiples, Dr Ross continues, the 'personalities are relatively full-bodied, complete states capable of a range of emotions and behaviours.' The alters will have 'executive control some substantial amount of time over the person's life'. He stresses, and I repeat his emphasis, 'Complex MPD with over 15 alter personalities and complicated amnesia barriers are associated with 100 percent frequency of childhood physical, sexual and emotional abuse.' Did I imagine the castle, the dungeon, the ritual orgies and violations? Did Lucy, Billy, Samuel, Eliza, Shirley and Kato make it all up? I went back to the industrial estate and found the castle. It was an old factory that had burned to the ground, but the charred ruins of the basement remained. I closed my eyes and could see the black candles, the dancing shadows, the inverted pentagram, the people chanting through hooded robes. I could see myself among other children being abused in ways that defy imagination. I have no doubt now that the cult of devil worshippers was nothing more than a ring of paedophiles, the satanic paraphernalia a cover for their true lusts: the innocent bodies of young children.

Stigma takes many forms, comes from all directions, is sometimes blatantly overt, but can also be remarkably subtle. It is the cruel comment, the unkind smirk, the extrusion from the group, the lost job opportunity, the rejected marriage proposal, the ineligibility for life insurance, the inability to adopt a child or pilot a plane. But it is also the reduced expectation, the helping hand when none is needed or wanted, the solicitous sympathy that one cannot really be expected to measure up. And the secondary psychological and practical harms of having a mental disorder come only partly from how others see you. A great deal of the trouble comes from the change in how you see yourself: the sense of being damaged goods, feeling not normal or worthy, not a full fledged member of the group. It is bad enough that stigma is so often associated with having a mental disorder, but the stigma that comes from being mislabeled with a fake diagnosis is a dead loss with absolutely no redeeming features.

The data on organised abuse has been simplified or distorted in an attempt force it to conform to mechanical psychological models of dissociative obedience or else to the psychiatric framework of ‘paedophilia’. Psychopathology alone is an inadequate explanation for environments in which sexual abuse has a social and symbolic function for groups of adults. Abusive groups do not emerge in a vacuum but rather they are formed within pre-existing social arrangements such as families, churches and schools.

My other client, whom I will call Teresa, thought Lorraine had MPD and hoped I could help her. Almost no one recognized this condition in those days. Lorraine was forty years old and had been in and out of psychiatric hospitals since she was thirteen. She had had various diagnoses, mainly severe depression, and she had made quite a few serious suicide attempts before I even met her. She had been given many courses of electric shock therapy, which would confuse her so much that she could not get together a coherent suicide plan for quite a while. Lorraine’s psychiatrist was initially opposed to my seeing her, as her friend Teresa had been stigmatized with the "borderline personality disorder" diagnosis when in hospital, so was seen as a bad influence on her. But after Lorraine spent a couple of months in hospital calling herself Susie and acting consistently like a child, he was humble enough to acknowledge that perhaps he could learn some new things, and someone else’s help might be a good idea.

Frosh (2002) has suggested that therapeutic spaces provide children and adults with the rare opportunity to articulate experiences that are otherwise excluded from the dominant symbolic order. However, since the 1990s, post-modern and post-structural theory has often been deployed in ways that attempt to ‘manage’ from; afar the perturbing disclosures of abuse and trauma that arise in therapeutic spaces (Frosh 2002). Nowhere is this clearer than in relation to organised abuse, where the testimony of girls and women has been deconstructed as symptoms of cultural hysteria (Showalter 1997) and the colonisation of women’s minds by therapeutic discourse (Hacking 1995). However, behind words and discourse, ‘a real world and real lives do exist, howsoever we interpret, construct and recycle accounts of these by a variety of symbolic means’ (Stanley 1993: 214). Summit (1994: 5) once described organised abuse as a ‘subject of smoke and mirrors’, observing the ways in which it has persistently defied conceptualisation or explanation. Explanations for serious or sadistic child sex offending have typically rested on psychiatric concepts of ‘paedophilia’ or particular psychological categories that have limited utility for the study of the cultures of sexual abuse that emerge in the families or institutions in which organised abuse takes pace. For those clinicians and researchers who take organised abuse seriously, their reliance upon individualistic rather than sociological explanations for child sexual abuse has left them unable to explain the emergence of coordinated, and often sadistic, multi—perpetrator sexual abuse in a range of contexts around the world.

Of course, the diagnosis of PTSD was only itself introduced into psychiatry in 1980. At first, it was seen as something rare, a condition that only affected a minority of soldiers who had been devastated by combat experiences. But soon the same kinds of symptoms—intrusive thoughts about the traumatic event, flashbacks, disrupted sleep, a sense of unreality, a heightened startle response, extreme anxiety—began to be described in rape survivors, victims of natural disaster and people who’d had or witnessed life-threatening accidents or injuries. Now the condition is believed to affect at least 7 percent of all Americans and most people are familiar with the idea that trauma can have profound and lasting effects. From the horrors of the 9/11 terrorist attacks to the aftermath of Hurricane Katrina, we recognize that catastrophic events can leave indelible marks on the mind.

The whole tradition of [oral] story telling is endangered by modern technology. Although telling stories is a very fundamental human attribute, to the extent that psychiatry now often treats 'narrative loss' -- the inability to construct a story of one's own life -- as a loss of identity or 'personhood,' it is not natural but an art form -- you have to learn to tell stories. The well-meaning mother is constantly frustrated by the inability of her child to answer questions like 'What did you do today?' (to which the answer is usually a muttered 'nothing' -- but the 'nothing' is cover for 'I don't know how to tell a good story about it, how to impose a story shape on the events'). To tell stories, you have to hear stories and you have to have an audience to hear the stories you tell. Oral story telling is economically unproductive -- there is no marketable product; it is out with the laws of patents and copyright; it cannot easily be commodified; it is a skill without monetary value. And above all, it is an activity requiring leisure -- the oral tradition stands squarely against a modern work ethic....Traditional fairy stories, like all oral traditions, need the sort of time that isn't money. "The deep connect between the forests and the core stories has been lost; fairy stories and forests have been moved into different categories and, isolated, both are at risk of disappearing, misunderstood and culturally undervalued, 'useless' in the sense of 'financially unprofitable.

Every child in the world imagines that its phantasy world is unique to itself. Psychiatry knows that the joys and terrors of private phantasies are a common heritage shared by all mankind. Fears, guilts, terrors, and shames could be interchanged, from one man to the next, and none would notice the difference.

Yet even as the hospitals were being closed, psychiatry’s reach was spreading wide outside the asylum, like ground ivy, into Hollywood, government, education, child-rearing, politics, and big business, enjoying a sudden social cachet while turning its back on the people who needed help the most—the seriously mentally ill.

Painful or frightening affect becomes traumatic when the attunement that the child needs to assist in its tolerance, containment, and integration is profoundly absent,”8 writes Robert Stolorow, a philosopher, psychologist, and clinical professor of psychiatry at UCLA, in his book about trauma. “One consequence of developmental trauma, relationally conceived, is that affect states take on enduring, crushing meanings. From recurring experiences of malattunement, the child acquires the unconscious conviction that unmet developmental yearnings and reactive painful feeling states are manifestations of a loathsome defect or of an inherent inner badness.

Despite what you might think, NORMAL people do NOT cause problems, misfortunes, conflicts, distress or accidents. And when they do, they CAN apologize and recognize their negative influence. A person that causes these things and can’t assume any responsibility for them is, apart from showing the cognitive and moral level of a child, deserving nothing more than abandonment, because she is dangerous at all levels and can hurt, or even kill, someone BY ACCIDENT, including herself and whoever is with her. A person like this DOES NOT deserve any TRUST for ANYTHING, ABSOLUTELY ANYTHING.

Criminalization and interdiction have filled prisons and corrupted governments in country after country. However, increasingly potent drugs that can be synthetized in any basement make controlling access increasingly impossible. Legalization seems like a good idea but causes more addiction. Our strongest defense is likely to be education, but scare stories make kids want to try drugs. Every child should learn that drugs take over the brain and turn some people into miserable zombies and that we have no way to tell who will get addicted the fastest. They should also learn that the high fades as addiction takes over.

Dr. Louis Jolyon “Jolly” West was born in New York City on October 6, 1924. He died of cancer on January 2, 1999. Dr. West served in the U.S. Army during World War II and received his M.D. from the University of Minnesota in 1948, prior to Air Force LSD and MKULTRA contracts carried out there. He did his psychiatry residency from 1949 to 1952 at Cornell (an MKULTRA Institution and site of the MKULTRA cutout The Human Ecology Foundation). From 1948 to 1956 he was Chief, Psychiatry Service, 3700th USAF Hospital, Lackland Air Force Base, San Antonio, Texas Psychiatrist-in-Chief, University of Oklahoma Consultant in Psychiatry, Oklahoma City Veterans Administration Hospital Consultant in Psychiatry. [...] Dr. West was co-editor of a book entitled Hallucinations, Behavior, Experience, and Theory[285]. One of the contributors to this book, Theodore Sarbin, Ph.D., is a member of the Scientific and Professional Advisory Board of the False Memory Syndrome Foundation (FMSF). Other members of the FMSF Board include Dr. Martin Orne, Dr. Margaret Singer, Dr. Richard Ofshe, Dr. Paul McHugh, Dr. David Dinges, Dr. Harold Lief, Emily Carota Orne, and Dr. Michael Persinger. The connections of these individuals to the mind control network are analyzed in this and the next two chapters. Dr. Sarbin[272] (see Ross, 1997) believes that multiple personality disorder is almost always a therapist-created artifact and does not exist as a naturally-occurring disorder, a view adhered to by Dr. McHugh[188], [189], Dr. Ofshe[213] and other members of the FMSF Board[191], [243]. Dr. Ofshe is a colleague and co-author of Dr. Singer[214], who is in turn a colleague and co author of Dr. West[329]. Denial of the reality of multiple personality by these doctors in the mind control network, who are also on the FMSF Scientific and Professional Advisory Board, could be disinformation. The disinformation could be amplified by attacks on specialists in multiple personality as CIA conspiracy lunatics[3], [79], [191], [213]. The FMSF is the only organization in the world that has attacked the reality of multiple personality in an organized, systematic fashion. FMSF Professional and Advisory Board Members publish most of the articles and letters to editors of psychiatry journals hostile to multiple personality disorder.

Delusions Dissociative disorders, even those created by mind controllers, are not psychosis, but this program will create the most common symptom used to diagnose schizophrenia. The child is hurt while on a turntable, with people and television sets and cartoons and photographs all around the turntable. New alters created by the torture are instructed that they must obey their instructions and become the people around them, people on television, or other alters when they are told to. When this program is triggered, the survivor will hear “voices” of the people whom the "copy alters” are imitating, or will have many confused alters popping out who think they are actually other people or movie stars. The identities of the copy alters change when the survivor's surrounding change.

The case of a patient with dissociative identity disorder follows: Cindy, a 24-year-old woman, was transferred to the psychiatry service to facilitate community placement. Over the years, she had received many different diagnoses, including schizophrenia, borderline personality disorder, schizoaffective disorder, and bipolar disorder. Dissociative identity disorder was her current diagnosis. Cindy had been well until 3 years before admission, when she developed depression, "voices," multiple somatic complaints, periods of amnesia, and wrist cutting. Her family and friends considered her a pathological liar because she would do or say things that she would later deny. Chronic depression and recurrent suicidal behavior led to frequent hospitalizations. Cindy had trials of antipsychotics, antidepressants, mood stabilizers, and anxiolytics, all without benefit. Her condition continued to worsen. Cindy was a petite, neatly groomed woman who cooperated well with the treatment team. She reported having nine distinct alters that ranged in age from 2 to 48 years; two were masculine. Cindy’s main concern was her inability to control the switches among her alters, which made her feel out of control. She reported having been sexually abused by her father as a child and described visual hallucinations of him threatening her with a knife. We were unable to confirm the history of sexual abuse but thought it likely, based on what we knew of her chaotic early home life. Nursing staff observed several episodes in which Cindy switched to a troublesome alter. Her voice would change in inflection and tone, becoming childlike as ]oy, an 8-year-old alter, took control. Arrangements were made for individual psychotherapy and Cindy was discharged. At a follow-up 3 years later, Cindy still had many alters but was functioning better, had fewer switches, and lived independently. She continued to see a therapist weekly and hoped to one day integrate her many alters.

Of course, the diagnosis of PTSD was only itself introduced into psychiatry in 1980. At first, it was seen as something rare, a condition that only affected a minority of soldiers who had been devastated by combat experiences. But soon the same kinds of symptoms—intrusive thoughts about the traumatic event, flashbacks, disrupted sleep, a sense of unreality, a heightened startle response, extreme anxiety—began to be described in rape survivors, victims of natural disaster, and people who’d had or witnessed life-threatening accidents or injuries. Now the condition is believed to affect at least 7 percent of all Americans and most people are familiar with the idea that trauma can have profound and lasting effects. From the horrors of the 9/11 terrorist attacks to the aftermath of Hurricane Katrina, we recognize that catastrophic events can leave indelible marks on the mind. We know now—as my research and that of so many others has ultimately shown—that the impact is actually far greater on children than it is on adults.

Prior to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the diagnosis of Dissociative Identity Disorder had been referred to as Multiple Personality Disorder. The renaming of this diagnosis has caused quite a bit of confusion among professionals and those who live with DID. Because dissociation describes the process by which DID begins to develop, rather than the actual outcome of this process (the formation of various personalities), this new term may be a bit unclear. We know that the diagnosis is DID and that DID is what people say we have. We’d just like to point out that words sometimes do not describe what we live with. For people like us, DID is just a step on the way to where we live—a place with many of us inside! We just want people who have little ones and bigger ones living inside to know that the title Dissociative Identity Disorder sounds like something other than how we see ourselves—we think it is about us having different personalities. Regardless of the term, it is clear that, in general, the different personalities develop as a reaction to severe trauma. When the person dissociates, they leave their body to get away from the pain or trauma. When this defense is not strong enough to protect the person, different personalities emerge to handle the experience. These personalities allow the child to survive: when the child is being harmed or experiencing traumatic episodes, the other personalities take the pain and/ or watch the bad things. This allows these children to return to their body after the bad things have happened without any awareness of what has occurred. They do this to create different ways to make sense of the harm inflicted upon them; it is their survival mechanism.

The traditional hospital practice of excluding parents ignored the importance of attachment relationships as regulators of the child’s emotions, behaviour and physiology. The child’s biological status would be vastly different under the circumstances of parental presence or absence. Her neurochemical output, the electrical activity in her brain’s emotional centres, her heart rate, blood pressure and the serum levels of the various hormones related to stress would all vary significantly. Life is possible only within certain well-defined limits, internal or external. We can no more survive, say, high sugar levels in our bloodstream than we can withstand high levels of radiation emanating from a nuclear explosion. The role of self-regulation, whether emotional or physical, may be likened to that of a thermostat ensuring that the temperature in a home remains constant despite the extremes of weather conditions outside. When the environment becomes too cold, the heating system is switched on. If the air becomes overheated, the air conditioner begins to work. In the animal kingdom, self-regulation is illustrated by the capacity of the warm-blooded creature to exist in a broad range of environments. It can survive more extreme variations of hot and cold without either chilling or overheating than can a coldblooded species. The latter is restricted to a much narrower range of habitats because it does not have the capacity to self-regulate the internal environment. Children and infant animals have virtually no capacity for biological self-regulation; their internal biological states—heart rates, hormone levels, nervous system activity — depend completely on their relationships with caregiving grown-ups. Emotions such as love, fear or anger serve the needs of protecting the self while maintaining essential relationships with parents and other caregivers. Psychological stress is whatever threatens the young creature’s perception of a safe relationship with the adults, because any disruption in the relationship will cause turbulence in the internal milieu. Emotional and social relationships remain important biological influences beyond childhood. “Independent self-regulation may not exist even in adulthood,” Dr. Myron Hofer, then of the Departments of Psychiatry and Neuroscience at Albert Einstein College of Medicine in New York, wrote in 1984. “Social interactions may continue to play an important role in the everyday regulation of internal biologic systems throughout life.” Our biological response to environmental challenge is profoundly influenced by the context and by the set of relationships that connect us with other human beings. As one prominent researcher has expressed it most aptly, “Adaptation does not occur wholly within the individual.” Human beings as a species did not evolve as solitary creatures but as social animals whose survival was contingent on powerful emotional connections with family and tribe. Social and emotional connections are an integral part of our neurological and chemical makeup. We all know this from the daily experience of dramatic physiological shifts in our bodies as we interact with others. “You’ve burnt the toast again,” evokes markedly different bodily responses from us, depending on whether it is shouted in anger or said with a smile. When one considers our evolutionary history and the scientific evidence at hand, it is absurd even to imagine that health and disease could ever be understood in isolation from our psychoemotional networks. “The basic premise is that, like other social animals, human physiologic homeostasis and ultimate health status are influenced not only by the physical environment but also by the social environment.” From such a biopsychosocial perspective, individual biology, psychological functioning and interpersonal and social relationships work together, each influencing the other.

Theo’s continuing refusal to speak in front of anyone other than Ben, and him only rarely, sounded very much like a condition called selective mutism. She hadn’t liked to interfere initially, she said, but it was a condition which Helen knew a little about through a friend of her late husband’s who worked in child psychiatry. If she was right, it was something which would definitely need expert help and which was almost always triggered by extreme anxiety.

The second factor helping to bring the dissociative disorders back into the mainstream was the Vietnam War. For sociological reasons originating outside psychology and psychiatry, the Vietnam War and the posttraumatic stress disorder (PTSD) that arose from it were not forgotten when the veterans returned home, as had been the case in the two world wars and the Korean War. The realization that real, severe trauma could have serious long-term psychopathological consequences was forced on society as a whole by Vietnam. Once this principle was accepted, it as a short leap to the conclusion that severe childhood trauma might have serious sequelae lasting into adulthood.

The more than 2,500 respondents to the WCS that I constructed while at the University of Missouri reported that they “occasionally” experienced the pain of a loved one at a distance. In Stevenson’s review of 160 published simulpathity cases, one-third involved a parent and child. Friends and acquaintances were in- volved in about 28 percent. Husband and wife pairs were involved in about 14 per- cent and siblings about 15 percent. The similar relatively high percentages of par- ent-child and friend-acquaintance simulpathity suggests that emotional bonds, rather than genetic similarities, facilitate these interactions. Stevenson’s reports are well-documented by follow-up interviews with both the coincider and the people who witnessed the event. I decided to name this coincidence pattern simulpathity, from the Latin word simul, which means “simultaneous,” and the Greek root pathy, which means both “suffering” and “feeling,” as in the words sympathy and empathy. With sympathy (“suffering together”), the sympathetic person is aware of the suffering of the other. With simulpathity, the person involved is usually not consciously aware of the suffering of the other (except for those pairs with whom this shared pain is a regular occurrence). Only later is the simultaneity of the distress recognized. No explanatory mechanism is implied.

Pretend for a moment that you are in the horrifying situation of watching one of your children being pulled out to sea in a riptide. Would you just go on eating your lunch? No way. The first thing you would do is to scream to get help rescuing your child. You would simultaneously get all other children out of the water as you dive in and try to rescue the missing child, even knowing the danger and that it is probably too late. If you were sensible enough not to swim out or fortunate enough to get back to shore safely, grief would promote endless rumination about what you could have done to prevent the loss. This would help prevent a repetition with other children. Your sobbing would signal your need for help and warn others about the danger. When a child dies of cancer or pneumonia, speculating about what you might have done to prevent it is mostly useless. However, the tendency to blame is built in, so people do it anyway, blaming themselves, doctors, anyone who was involved. Those motives can create marvelous initiatives, Mothers Against Drunk Driving being a spectacular example. Every community has organizations dedicated to preventing the kind of sickness or accident that carried off a loved member of the community. In our ancestral environment, loved ones must often have simply not returned to camp. Searching for them would have been essential. A loss creates mental preoccupation and a search image tuned to detect relevant cues. In the weeks after a loss, bereaved individuals often think that they see or hear the lost loved one. Tiny random sounds or sights are misinterpreted as the person’s voice or form. Visual and auditory hallucinations arise. Such experiences are sometimes interpreted as wish fulfillment, but a more plausible explanation is that they are products of a search image that makes it easier to find the missing person. False alarms in such a system would be normal, useful, and experienced as ghosts. Anniversary reactions are also common and fascinating. Many people occasionally experience sadness that seems unaccountable, until they realize it is the anniversary of a loss. I doubt that anniversary reactions are adaptive in general; however, in ancestral environments many opportunities and dangers recur with seasonal regularity. So smelling overly ripe apples in an orchard may bring back vivid memories of a fall long ago.

While I was doing my fellowship in child and adolescent psychiatry, my family and I lived in Hawaii. When my son was seven years old, I took him to a marine life educational and entertainment park for the day. We went to the killer whale show, the dolphin show, and finally the penguin show. The penguin’s name was Fat Freddie. He did amazing things: He jumped off a twenty-foot diving board; he bowled with his nose; he counted with his flippers; he even jumped through a hoop of fire. I had my arm around my son, enjoying the show, when the trainer asked Freddie to get something. Freddie went and got it, and he brought it right back. I thought, “Whoa, I ask this kid to get something for me, and he wants to have a discussion with me for twenty minutes, and then he doesn’t want to do it!” I knew my son was smarter than this penguin. I went up to the trainer afterward and asked, “How did you get Freddie to do all these really neat things?” The trainer looked at my son, and then she looked at me and said, “Unlike parents, whenever Freddie does anything like what I want him to do, I notice him! I give him a hug, and I give him a fish.” The light went on in my head. Whenever my son did what I wanted him to do, I paid little attention to him, because I was a busy guy, like my own father. However, when he didn’t do what I wanted him to do, I gave him a lot of attention because I didn’t want to raise a bad kid! I was inadvertently teaching him to be a little monster in order to get my attention. Since that day, I have tried hard to notice my son’s good acts and fair attempts (although I don’t toss him a fish, since he doesn’t care for them) and to downplay his mistakes. We’re both better people for it. I collect penguins as a way to remind myself to notice the good things about the people in my life a lot more than the bad things. This has been so helpful for me as well as for many of my patients. It is often necessary to have something that reminds us of this prescription. It’s not natural for most of us to notice what we like about our life or what we like about others, especially if we unconsciously use turmoil to stimulate our prefrontal cortex. Focusing on the negative aspects of others or of your own life makes you more vulnerable to depression and can damage your relationships.

In families in which parents are overbearing, rigid, and strict, children grow up with fear and anxiety. The threat of guilt, punishment, the withdrawal of love and approval, and, in some cases, abandonment, force children to suppress their own needs to try things out and to make their own mistakes. Instead, they are left with constant doubts about themselves, insecurities, and unwillingness to trust their own feelings. They feel they have no choice and as we have shown, for many, they incorporate the standards and values of their parents and become little parental copies. They follow the prescribed behavior suppressing their individuality and their own creative potentials. After all, criticism is the enemy of creativity. It is a long, hard road away from such repressive and repetitive behavior. The problem is that many of us obtain more gains out of main- taining the status quo than out of changing. We know, we feel, we want to change. We don’t like the way things are, but the prospect of upsetting the stable and the familiar is too frightening. We ob- tain “secondary gains” to our pain and we cannot risk giving them up. I am reminded of a conference I attended on hypnosis. An el- derly couple was presented. The woman walked with a walker and her husband of many years held her arm as she walked. There was nothing physically wrong with her legs or her body to explain her in- ability to walk. The teacher, an experienced expert in psychiatry and hypnosis, attempted to hypnotize her. She entered a trance state and he offered his suggestions that she would be able to walk. But to no avail. When she emerged from the trance, she still could not, would not, walk. The explanation was that there were too many gains to be had by having her husband cater to her, take care of her, do her bidding. Many people use infirmities to perpetuate relationships even at the expense of freedom and autonomy. Satisfactions are derived by being limited and crippled physically or psychologically. This is often one of the greatest deterrents to progress in psychotherapy. It is unconscious, but more gratification is derived by perpetuating this state of affairs than by giving them up. Beatrice, for all of her unhappiness, was fearful of relinquishing her place in the family. She felt needed, and she felt threatened by the thought of achieving anything 30 The Self-Sabotage Cycle that would have contributed to a greater sense of independence and self. The risks were too great, the loss of the known and familiar was too frightening. Residing in all of us is a child who wants to experiment with the new and the different, a child who has a healthy curiosity about the world around him, who wants to learn and to create. In all of us are needs for security, certainty, and stability. Ideally, there develops a balance between the two types of needs. The base of security is present and serves as a foundation which allows the exploration of new ideas and new learning and experimenting. But all too often, the security and dependency needs outweigh the freedom to explore and we stifle, even snuff out, the creative urges, the fantasy, the child in us. We seek the sources that fill our dependency and security needs at the expense of the curious, imaginative child. There are those who take too many risks, who take too many chances and lose, to the detriment of all concerned. But there are others who are risk-averse and do little with their talents and abilities for fear of having to change their view of themselves as being the child, the dependent one, the protected one. Autonomy, independence, success are scary because they mean we can no longer justify our needs to be protected. Success to these people does not breed success. Suc- cess breeds more work, more dependence, more reason to give up the rationales for moving on, away from, and exploring the new and the different.

Some people, who never engaged in any research about DID, claim that there is no connection between child abuse and DID. Then they unwittingly contradict themselves by stating DID doesn’t even exist. DSM-5 concluded from the rigorous research into DID: “Interpersonal physical and sexual abuse is associated with an increased risk of dissociative identify disorder. Prevalence of childhood abuse and neglect in the United States, Canada and Europe among those with the disorder is close to 90%.

1943, when Leo Kanner, a physician at Johns Hopkins University and a pioneer in child psychiatry, proposed it in a paper.

Children in our culture are familiar with transformation of identity from comics, movies, television, and books. Who has not watched a child zooming around on the sidewalk or in the backyard, pretending to be a superhero or some other figure? Who can doubt the child's intensity of imaginative involvement in this transformation? I think it is reasonable to say that the normal child partly believes in this transformation on a transient basis. It is not necessary to wonder where the MPD child gets the idea of creating someone else inside to cope with the abuse. The strategy of transformation of identity to gain strength, coping power, even and vulnerability is readily available in the child's environment.

Parental investment theory predicts that, on average, the sex that invests more in its offspring, including the size of gametes, gestation, lactation and child rearing, will be more selective when choosing a mate, and the less-investing sex will engage in more intra-sexual competition for access to mates.

In an August 2015 study published in Biological Psychiatry, Yehuda and her team at New York’s Mount Sinai Hospital demonstrated that gene changes could be transmitted from parents to their children. Analyzing a particular region of the FKBP5 gene, which is associated with stress regulation, Yehuda and her team found that Jews who had experienced trauma during the Holocaust, and their children, shared a similar genetic pattern. Specifically, they found epigenetic tags on the very same part of the gene in both parent and child. They compared the results with Jewish

. . . military psychologists tell me that the best practitioners in their field are those trained in child psychiatry; eighteen- and nineteen-year-old men are, in the clinician's view, still children.

but do we know whether overparenting causes this rise in mental health problems? The answer is that we don’t have studies proving causation, but a number of recent studies show correlation. A study published in 2006 by UCLA clinical child psychologist and assistant professor of psychiatry and education, James Wood, found that parents who tend to take over tasks that children either are or could be performing independently limit the child’s ability to experience “mastery,” leading to greater rates of separation anxiety in their children.

Anna O.'s real name was Bertha Pappenheim. Bertha Pappenheim became one of the first social workers in Europe. Her work was recognized in a commemorative German stamp issued in 1954. She was also an early feminist. Her work involved the establishing of homes for prostitutes and unwed mothers. It is possible that, and psychoanalytic terms, this career was on undoing of her own childhood sexual trauma and of the failure of any person in authority to validate its reality or offer comfort.

It is also important to note that not all pathological presentations are caused by the environment. A child may have underlying difficulties such as intellectual disabilities or other neurodevelopmental disorders. On the other hand, just because a child has survived unscathed does not mean that the environment was benign. We know that some children are naturally less sensitive to environmental influences and as such are more resilient to harsh environments.

The fundamental importance, for the recovery of people in Western industrial societies who are sickened by a one-sided, rational, materialistic world view, is today given primary emphasis, not only by adherents to Eastern religious movements like Zen Buddhism, but also by leading representatives of acedemic psychiatry

The fundamental importance, for the recovery of people in Western industrial societies who are sickened by a one-sided, rational, materialistic world view, is today given primary emphasis, not only by adherent to Eastern religious movements like Zen Buddhism, but also by leading representatives of acedemic psychiatry

That these people were in many cases deprived nevertheless of what was most crucial for them does not yet seem to be understood, even among professionals. It has by no means become common knowledge in our society that a child's psychological nourishment derives from the understanding and respect provided by his or her first attachment figures and that child-rearing and manipulation cannot take the place of this nourishment. On the contrary, recent developments in psychology, psychotherapy, and psychiatry reveal a tendency to favor "strategic techniques" and to deny collectively the significance of childhood traumas, with psychopharmaceutical treatment replacing corporal punishment. If someone attempts to talk to his doctor about his childhood, he is given pills to keep him from becoming "overly agitate." On the surface, everything possible is being done to spare the patient, but in reality it is the therapist's feared, internalized parents who are being spare at the cost of the patient's failure to discover his own truth.

Para poder desenvolverse socialmente, la gente necesita desarrollar lo que se conoce como "teoría de la mente". Dicho de otro modo, necesitan saber que las demás personas son distintas a ellos, que tienen un conocimiento distinto del mundo, así como deseos e intereses diferentes a los suyos.

...tendemos a preferir la "certeza de la miseria a la miseria de la incertidumbre".

Child and Adolescent Psychiatry at NYU, showed that when children were hospitalized for treatment of severe burns, the development of PTSD could be predicted by how safe they felt with their mothers.31 The security of their attachment to their mothers predicted the amount of morphine that was required to control their pain—the more secure the attachment, the less painkiller was needed.

Early in the evolution of Mister Rogers’ Neighborhood, Rogers offered this definitive observation to a meeting of the American Academy of Child Psychiatry: “It’s easy to convince people that children need to learn the alphabet and numbers. . . . How do we help people to realize that what matters even more than the superimposition of adult symbols is how a person’s inner life finally puts together the alphabet and numbers of his outer life? What really matters is whether he uses the alphabet for the declaration of war or the description of a sunrise—his numbers for the final count at Buchenwald or the specifics of a brand-new bridge.”13

Alvin Poussaint carried first aid material, in case King was shot. Poussaint also provided medical and psychological support for the marchers. A medical car (usually Poussaint’s own car with an affixed red cross) trailed each march. Dr. Poussaint, now a child psychiatry professor at Harvard, gave me a firsthand assessment of King’s mental state in the final years of his life. Poussaint knew Dr. King reasonably well from the marches.

Every child in the world imagines that its phantasy world is unique to itself. Psychiatry knows that the joys and terrors of private phantasies are a common heritage shared by all mankind. Our fears, guilts, terrors and shames could be interchanged, from one man to the next, and none would notice the difference. The therapy department at Combined Hospital had recorded thousands of emotional tapes and boiled them down to one all-inclusive all-terrifying performance in Nightmare Theatre.

Emotional Labour: The f Word, by Jane Caro and Catherine Fox "Work inside the home is not always about chores. One of the most onerous roles is managing the dynamics of the home. The running of the schedule, the attention to details about band practice and sports training, the purchase of presents for next Saturday’s birthday party, the check up at the dentist, all usually fall on one person's shoulders. Woody Allen, in the much-publicised custody case for his children with Mia Farrow, eventually lost, in part because unlike Farrow, he could not name the children’s dentist or paediatrician. It’s a guardianship role and it is not only physically time consuming but demands enormous intellectual and emotional attention. Sociologists call it kin work. It involves: 'keeping in touch with relations, preparing holiday celebrations and remembering birthdays. Another aspect of family work is being attentive to the emotions within a family - what sociologists call ‘emotion work.’ This means being attentive to the emotional tone among family members, troubleshooting and facing problems in a constructive way. In our society, women do a disproportionate amount of this important work. If any one of these activities is performed outside the home, it is called work - management work, psychiatry, event planning, advance works - and often highly remunerated. The key point here is that most adults do two important kinds of work: market work and family work, and that both kinds of work are required to make the world go round.' (Interview with Joan Williams, mothersandmore.org, 2000) This pressure culminates at Christmas. Like many women, Jane remembers loving Christmas as a child and young woman. As a mother, she hates it. Suddenly on top of all the usual paid and unpaid labour, there is the additional mountain of shopping, cooking, cleaning, decorating, card writing, present wrapping, ritual phone calls, peacekeeping and emotional care taking. And then on bloody Boxing Day it all has to be cleaned up. If you want to give your mother a fabulous Christmas present just cancel the whole thing. Bah humbug!

A 2013 study in the Journal of the American Academy of Child and Adolescent Psychiatry found that two-thirds of children who say they believe they were born the wrong gender change their minds and come to accept their biological sex. Another study, by clinical psychologist Devita Singh, found that without adult intervention, 88 percent of kids ultimately evolve out of gender confusion

The data had convinced him that unless you understand the language of trauma and abuse, you cannot really understand BPD. As we later reported in the American Journal of Psychiatry, 81 percent of the patients diagnosed with BPD at Cambridge Hospital reported severe histories of child abuse and/or neglect; in the vast majority the abuse began before age seven.4 This finding was particularly important because it suggested that the impact of abuse depends, at least in part, on the age at which it begins.

My former student Glenn Saxe, now chairman of the Department of Child and Adolescent Psychiatry at NYU, showed that when children were hospitalized for treatment of severe burns, the development of PTSD could be predicted by how safe they felt with their mothers.31 The security of their attachment to their mothers predicted the amount of morphine that was required to control their pain—the more secure the attachment, the less painkiller was needed.

...Rogers offered this definitive observation to a meeting of the American Academy of Child Psychiatry: "It's easy to convince people that children need to learn the alphabet and numbers...How do we help people to realize that what matters even more than the superimposition of adult symbols is how a person's inner life finally puts together the alphabet and numbers of his outer life? What really matters is whether he uses the alphabet for the declaration of war or the description of a sunrise--his numbers for the final count at Buchenwald or the specifics of a brand-new bridge.

[T]he biological model of psychiatry appealed to parents who had often felt blamed when they took their child to a psychoanalytically oriented therapist. Parents became resistant when therapists began suggesting making changes to their parenting model as part of their children's treatment. [...] [P]arents found relief in the idea that their child suffered from a real biological illness, in whose origins they or other family members played no role. [...] Instead of "blaming" parents for their children's problems, the new biological way of diagnosing children let parents off the hook entirely.

I believe ADHD is a constellation of symptoms that our society interprets as a medical condition [...]. ADHD certainly "exists," in the sense that many children exhibit behaviors that parents and teachers can see and doctors can measure. But in my view ADHD is neither an unnatural condition of childhood nor an illness that requires medication. Often, behaviors tagged as ADHD are normal childhood responses to stressful situations. I believe ADHD is overdiagnosed and overmedicated and that well-meaning parents from all backgrounds have been duped into believing that their perfectly normal and healthy child needs powerful psychostimulant medications just to be "normal" and successful. I believe this is harmful to parents and to children, and I believe there is a better way.

Instead of seeing ADHD-type behaviors as part of the spectrum of normal childhood that most kids eventually grow out of, or as responses to bumps or rough patches in a child's life, we cluster these behaviors into a discrete (and chronic) "illness" or "mental health condition" with clearly defined boundaries. And we are led to believe that this "illness" is rooted in the child's genetic makeup and requires treatment with psychiatric medication.

Like the psychological model outlined above, the psychiatric understanding of ’organised paedophilia’ is a framework that is focused primarily on individual psychological factors and overlooks the role of violence in criminal groups and the contexts in which such groups emerge. The underlying assumption of literature on ‘organised paedophilia’ is that members of sexually abusive groups are motivated by a pathological sexual interest in children but this does not accord with evidence that suggests that abusive groups can simultaneously abuse children and women. It is increasingly recognised that sexual offenders may not specialise in one particular victim category, and a significant proportion of child sexual abusers have also offended against adults (Cann et al. 2007, Heil et al. 2003). Furthermore, many of the behaviours of abusive groups appear to be designed to elicit fear and pain from the victim rather than to generate sexual pleasure for the perpetrator per se., are not mutually exclusive, but there is a sadistic dimension to organised abuse that is not explicable as ‘paedophilic’. A survivor of organised abuse from Belgium, Regina Louf, made this point clearly when she said: I find the expression ‘paedophile network’ misleading. For me paedophiles are those men who go to playgrounds or swimming pools, priests…I certainly don't want to exonerate them, but I would rather have paedophiles than the types we were involved with. There were men who never touched the children. Whether you were five, ten, or fifteen didn’t matter. What mattered to them was sex, power, experience. To do things they would never have tried with their own wives. Among them were some real sadists. (Louf quoted in Bulte and de Conick 1998) A credible theoretical account of organised abuse must necessarily (a) account for the available empirical evidence of organised abuse, (b) address the complex patterns of abuse and violence evident in sexually abusive groups, and (c) explain the ways in which sexually abusive groups form in a range of contexts, including families and institutions.

There are a range of useful and illuminating analyses of the media construction of organised abuse as it became front-page news in the 1980s and 1990s (Kitzinger 2004, Atmore 1997, Kelly 1998), but this book is focused on organised abuse as a criminal practice; as well as a discursive object of study, debate and disagreement. These two dimensions of this topic are inextricably linked because precisely where and how organised abuse is reported to take place is an important determinant of how it is understood. Prior to the 1980s, the predominant view of the police, psychiatrists and other authoritative professionals was that organised abuse occurred primarily outside the family where it was committed by extra-familial ‘paedophiles’. This conceptualisation; of organised abuse has received enduring community support to the present day, where concerns over children’s safety is often framed in terms of their vulnerability to manipulation by ‘paedophiles’ and ‘sex rings’. This view dovetails more generally with the medico-legal and media construction of the ‘paedophile as an external threat to the sanctity of the family and community (Cowburn and Dominelli 2001) but it is confounded by evidence that organised abuse and other forms of serious sexual abuse often originates in the home or in institutions, such as schools and churches, where adults have socially legitimate authority over children.

As mandatory reporting laws and community awareness drove an increase its child protection investigations throughout the 1980s, some children began to disclose premeditated, sadistic and organised abuse by their parents, relatives and other caregivers such as priests and teachers (Hechler 1988). Adults in psychotherapy described similar experiences. The dichotomies that had previously associated organised abuse with the dangerous, external ‘Other’ had been breached, and the incendiary debate that followed is an illustration of the depth of the collective desire to see them restored. Campbell (1988) noted the paradox that, whilst journalists and politicians often demand that the authorities respond more decisively in response to a ‘crisis’ of sexual abuse, the action that is taken is then subsequently construed as a ‘crisis’. There has been a particularly pronounced tendency of the public reception to allegations of organised abuse. The removal of children from their parents due to disclosures of organised abuse, the provision of mental health care to survivors of organised abuse, police investigations of allegations of organised abuse and the prosecution of alleged perpetrators of organised abuse have all generated their own controversies. These were disagreements that were cloaked in the vocabulary of science and objectivity but nonetheless were played out in sensationalised fashion on primetime television, glossy news magazines and populist books, drawing textual analysis. The role of therapy and social work in the construction of testimony of abuse and trauma. in particular, has come under sustained postmodern attack. Frosh (2002) has suggested that therapeutic spaces provide children and adults with the rare opportunity to articulate experiences that are otherwise excluded from the dominant symbolic order. However, since the 1990s, post-modern and post-structural theory has often been deployed in ways that attempt to ‘manage’ from; afar the perturbing disclosures of abuse and trauma that arise in therapeutic spaces (Frosh 2002). Nowhere is this clearer than in relation to organised abuse, where the testimony of girls and women has been deconstructed as symptoms of cultural hysteria (Showalter 1997) and the colonisation of women’s minds by therapeutic discourse (Hacking 1995). However, behind words and discourse, ‘a real world and real lives do exist, howsoever we interpret, construct and recycle accounts of these by a variety of symbolic means’ (Stanley 1993: 214). Summit (1994: 5) once described organised abuse as a ‘subject of smoke and mirrors’, observing the ways in which it has persistently defied conceptualisation or explanation.