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The number of books on trauma, PTSD, and sexual abuse churned out each year is astounding. One is tempted to believe that there cannot be much left to be said on these thoroughly researched subjects. However, Sam Warner's Understanding the Effects of Childhood Abuse approaches, from an entirely novel angle, the theory, research and practice surrounding childhood sexual abuse. The result is a compelling study that forces an overturning of current assumptions about the way that the public and the psychological and legal "experts" understand the effects of sexual abuse on children and adults, and how this understanding affects treatment of survivors.
Sketching out the three areas of inquiry--theory, research, and practice--Warner demonstrates how the three are entwined, mutually informing each other and mutually constituting a "knowledge base" about women and girls and childhood sexual abuse, which configures mental health approaches and legal and healthcare services. Warner proposes a new approach, grounded in a marriage of two theoretical models, feminism and post-structuralism. Feminism problematizes the category women, refusing that term as a stable social category with fixed and definitive meaning; "if we are to claim a feminist voice, whilst not denying our differences, it is crucial to theorize, rather than simply accept gender distinctions" (p. 5). Post-structuralism offers the approach for this fresh theorizing, since "according to post-structuralism, reality is understood to be socially constructed through language" (p. 5). Post-structuralism assumes all knowledge, because it is all socially produced and regulated, to have epistemological equivalence. Thus, according to both feminism and post-structuralism, there is no "natural social order" into which "normal" individuals should neatly fit. Rather, discourses of normalcy and deviance are strategic, rather than transparent, because knowledge is never a benign thing but is a practice that has the power to influence. Knowledge is Power (Foucault, 1978, 1991, 1971/92). In patriarchal society, we cannot assume that expert knowledge is "pure" or "objective" but is necessarily influenced from the outset by the fact that males are both the dominant voice of the society and the most common abusers of women and children.
Once Warner helps us to appreciate the way the landscape of reality comes to be constituted through relationships of power and knowledge, then we see that we can now inquire into any phenomenon (such as child sexual abuse) from a rich array of angles, from the perspective of differing "epistemic communities." We come to appreciate that the groups and persons marginalized and subordinated in the society, whatever the disadvantages of marginalization, do have a singular benefit: they enjoy greater access to knowledge, since "structural privilege (such as male power) impedes clarity of thought [there being]no impetus to theorize the norm (what it means to be a man in patriarchal society)" (p. 5). The dominant in any social structural hierarchy are limited as to their understanding of themselves and their worlds, precisely because structures are organized in such a way as to hide the structures of domination, under the rubric of "the naturalized order of things." The marginalized epistemic communities, therefore, can offer rich starting points for research and social inquiry, unhindered by the myopia that handicaps the dominant.
The result of Warner's feminist-post-structuralist rethinking of the effects of child sexual abuse is nothing short of a revolution in psychology, culminating in a radical political agenda that transforms research, theory and practice as they relate to child sexual abuse. Warner's reframing of the accepted knowledge culminates in a new therapeutic approach, "Visible Therapy," which abandons the conceptual framework that currently guides treatment of vsurvivors of childhood sexual abuse, and challenges the language of diagnosis, symptoms, personality disorder, normalcy, and pathology. The charge Warner makes to traditional psychology and psychiatry is that once survivors of abuse are diagnosed, the symptoms that permit the diagnosis (voices, visions, denial, distraction, dissociation, and self-harm) are seen as qualities inhering in the diseased individual. That is to say, the behaviors, which compose the effects of childhood sexual abuse are dislocated from the event of abuse that gave rise to them.
Warner argues that the "symptoms" are better understood as coping strategies, to which the sufferer has turned to make sense of the abuse that she has endured. When her behaviors are seen--made visible--in this way, the patient often feels empowered, recognizing herself as a survivor of abuse, rather than remaining locked in the identity of "victim." The therapist may now lead the patient to explore and expand her arsenal of coping strategies to other more effective tactics, or at the least, she may help the patient to learn to exercise enhanced control over the (harmful) strategies she is employing.
Warner's recovery-focused model of psychotherapy valorizes the patient's ability to effect change in her own life, by helping her to appreciate the multiple factors that impact how she thinks and feels about what she has suffered and about what behaviors she has take up to work through her thoughts and feelings, in the aftermath of childhood sexual abuse. Visible Therapy avoids diagnosis and value judgments about behaviors; the aim is to make sense of experiences, past and present, that have shaped the mental and social life of the patient.
Warmer is a brave explorer, overturning the very knowledge base that frames diagnosis and guides treatment of sexual abuse survivors. Warner's feminist post-structuralist approach to the problem of childhood sexual abuse exposes the broader landscape of the problem, locating its roots in Power/Knowledge systems, in gender roles and master narratives about "normal" ways that women and girls should behave. Childhood sexual abuse is a worldwide social problem, and Warner's compelling study reveals that it is inequalities in gender relationships that underpin sexually exploitative and abusive relationships.
Understanding the Effects of Child Sexual Abuse is a refreshing new voice in violence and abuse studies. It is a must-read for practitioners in the field, as it offers a spectrum of practical therapeutic approaches to suit individual patients and situations. Students would benefit from Warner's study, as would any educated reader who is interested in rethinking the way our societies work to suppress some knowledge (such as "violence begins at home and generally at the hands of a male you know intimately") and elevate as "self-evident truth" other, more convenient understandings ("mental patients are personality-disordered").
© 2010 Wendy C. Hamblet
Wendy C. Hamblet, Ph.D. North Carolina A&T State University