In my books, Engaging Multiple Personalities Volume 1 and 2, I briefly discuss the fact that PTSD was not really acknowledged until the military was overwhelmed with veterans suffering from it. I pointed out some of the similarities between veterans with PTSD and DID patients whose trauma arose from very early childhood abuse. The key similarities are the inescapability of the danger and the resultant hyper-vigilance. The key difference in PTSD resulting from the battlefield is that a soldier has the support of other soldiers who understand the wartime environment whereas a child being abused is all alone, with no buddies, no peer group to support them or get them help.
There is now a report from the General Accountability Office of the US Federal government on the “staggering number of men in the military that have been sexually assaulted, and hinted at the underlying problem, writing: ‘DOD has recognized that a cultural change is needed to address sexual assaults but has not yet taken several key steps to further this change.’ For all victims, male and female, the environment frequently acts as a deterrent rather than a support structure; but for men the effect appears to be more significant.” http://www.huffingtonpost.com/rep-niki-tsongas/support-male-survivors-of-sexual-assault_b_7832846.html
It is a societal bias that the issue gets attention when it impacts men but no so much when it impacts women. This is simply wrong – terribly wrong. It has been known, and not particularly seen as a “staggering” problem, that women have been similarly victimized. However, the fact that sexual assault in the military is now being scrutinized may have a positive impact on men outside the military – particularly those abused as children – who have been sexually attacked. Hopefully the changes that the military makes to protect its men will similarly protect its women. From my experience treating both men and women who have been sexually abused, I think it is quite possible that the finding that “for men the effect appears to be more significant” will be seen as wrong – terribly wrong.
The information described in the article ties into my experience treating DID patients, where they were raised in an environment that was a deterrent to reporting and healing, where the risk of retaliation is stupendous, and where the assaulted individual has no safe option to confront their attacker(s). It is instructive that the language within the military report context talks about betrayal: “Retaliation compounds the injustice and personal betrayal survivors experience and has been a lasting concern among survivors, advocates and those of us in Congress fighting to institute reform.” Betrayal trauma is almost always a key component in child sexual abuse.
The SAPRO report acknowledges the high levels of retaliation, and in May a report conducted by Human Rights Watch drew similar conclusions. Human Rights Watch made the problem vividly clear by sharing candid stories from service members who experienced backlash firsthand.
It is interesting to note that many comments were made about this report questioning who was doing the assaulting. A specific concern was raised that, once again, those doing the assaulting were not being identified, called out or punished for their crimes. All of this is quite familiar to anyone with experience treating the trauma of early childhood abuse.
It is my hope that just as the military’s concerns about veterans ended up mainstreaming the understanding of PTSD, this report and any follow-up work will clarify for the therapeutic community that betrayal trauma has a lasting deep impact and must be understood and addressed. This is true whether that betrayal affects an adult in the military or a child living in a domestic war zone.
I see it as an optimistic sign that finally there is an opening that may force psychiatry to face the issue of trauma and possible dissociation directly. It is something we can no longer ignore or keep silent with the prescription of a pill.
