Sex Abuse Hysteria - The Physicians1
Richard A. Gardner*
We in the medical profession are part of the network of
people involved in the sex abuse hysteria. Psychiatrists, like the author,
have become involved as evaluators (we do not call ourselves
"validators") and as therapists. Unfortunately, there are
psychiatrists whose level of evaluation is no better than the validators
described in Chapter Six. Unfortunately, as well, there are psychiatrists
who "treat" the children who have been diagnosed as having been
sexually abused. Such psychiatrists accept these people as
"experts" and then "treat" the child. It would be an error
for the reader to assume that I have any less scorn for these medical
colleagues than I do for those in other professions who treat children for
sex abuse when there is little if any evidence that such abuse took place.
A recent development in the field of psychotherapeutic
psychiatry is the "uncovering" of early sex abuse that the
patient never realized took place. This has been very much in vogue during
the last few years. Sometimes, the process starts with the psychiatrist
"suspecting" sex abuse on the basis of allegedly derivative statements
and symptoms that are "suggestive" of early childhood sex abuse.
When the patient expresses puzzlement and even disbelief, he (she) is
encouraged to enter into a more meaningful and deeper (sometimes on the
couch) therapy in order to "uncover" these lost memories.
Human beings, suggestible and gullible animals that we
are, are likely to comply with the psychiatrist's prediction and provide
the psychiatrist with the "lost" material. Such patients, then,
go around the rest of their lives proudly telling others how they learned
in their treatment how they were sexually abused as children and that this
revelation not only served as an important advance in their treatment but
brought about other changes that would not have been possible without the
revelation. Some even believe that it was the sex abuse that was at the
root of many (if not most) of their problems and that now that it has been
brought into conscious awareness the symptoms that derive from it have
been reduced significantly, if not evaporated entirely.
Such a statement is testimony to the credulity of the
human being. It is patently preposterous if the sex abuse never took place
(a likely possibility). However, even if there was sex abuse, it is
extremely unlikely that most of the patient's problems were derived from
this experience (or even experiences). No symptom is caused by one event
or one type of event. Symptoms are multi-determined. Furthermore, insight
is only one small part of the therapeutic process. Such scenarios may make
good movies and novels, and may make the author a lot of money, but they
have nothing to do with real therapy as it takes place in the real world.
Interestingly, an even more recent development is the
suspicion by patients — arising within themselves — that they may have been
sexually abused and were not aware of it. Here, it was not the therapist
who suggested this possibility, but the patient. Like all phenomena, this
phenomenon has multiple determinants, which vary with each individual.
Perhaps some of the people actually were sexually abused and the
therapeutic inquiry is warranted. Others, I am certain, were never abused
but may be looking for a simple answer to explain their problems and, by
implication, a magical solution to their difficulties. Others, I am
certain, are just keeping with the Joneses and have been affected by the
mass hysteria phenomenon.
Physicians in other branches of medicine have also
become deeply involved. This is especially the case for pediatricians,
pediatric gynecologists, and people from other branches of medicine (such
as internal medicine and family practice) who have become experts" on
sex abuse in recent years. Those who diagnose sex abuse in the vast
majority of cases presented to them are generally attractive to
prosecutors who can rely upon them to provide the "definitive medical evidence" that is the "proof"
that sex abuse took place. Those who rarely find sex abuse are likely to
be engaged by defense attorneys in order for them to testify that the
child is "normal" and that there was "no evidence for sex
abuse." Although there are people who claim that they are completely
neutral, my experience has been that most people who are doing this king
of work have a reputation (whether warranted or not) for being in either
of the two camps.
There are doctors (even pediatricians) who claim that
any inflammation of a little girl's vulva is a manifestation of sex abuse.
Most, however, claim that this is an extremely common finding and can
result from sweat, tight pants, certain kinds of soap, and the occasional
mild rubbing (and masturbatory) activity of the normal girl. There are
some who hold that the normal hymen is a perfect circle (or close to it)
without any irregularities. It follows, then that if any irregularities
are found these must have been artificially created by the insertion of
something else (like a crayon or pencil). There are others who claim that
the normal hymen is most often not a circle and there are irregularities,
tags, and bumps. Others hold that these irregularities (referred to as a
serrated hymenal orifice) are within the normal range of hymenal variation
(I am in agreement with this group). Some claim that a three-year-old
girl's vagina can accommodate an adult's fingers and even penis without
necessarily showing signs of physical trauma — other than the production of
the aforementioned irregularities, tags, and bumps. Others claim that the
insertion of an adult male penis in a three-year-old girl's vagina will
produce severe pain, significant bleeding, and deep lacerations and that
the insertion of crayons and pencils at that age is extremely rare because
of the pain and trauma that such insertion will produce (again, I am in
agreement with this group).
There are significant differences of opinion regarding
what is the normal size of the hymenal opening and this, of course, bears
directly on the question of abuse. Most agree that there have not been large
studies of many children at different ages with regard to what the normal
hymen looks like, its size, and whether or not it is indeed circular.
Furthermore, all do agree that the older the child the greater the
likelihood the vaginal opening will accommodate a penis without
significant trauma and so that by the age of nine or ten one does not get
the same degree of trauma that one may get at younger ages. Most agree, as
well, that children of nine and ten, whose vaginal orifices are still
small, could still be brought to the point of intercourse with an adult by
gradual stretching of the vagina in the course of repeated experiences in
which progressively larger objects (fingers, and ultimately a penis) are
inserted. There are some who hold that a certain type of dilatation
("winking") of the anal mucosa is pathognomic of penile
penetration into the anus. There are others who claim that such dilatation
is normal (again, I am with the group that holds that the puckering
described here is most often normal and is not a manifestation of sex
The net result of this is that there are sharply
divided opinions among physicians regarding whether or not a particular
child has been sexually abused. However, this does not stop each side from
bringing in a parade of its own physicians who will predictably provide
the "proof" or "no proof' findings that are requested.
Another result is that many doctors are making a lot of money, especially
because providing court testimony can be quite remunerative. Wakefield and
Underwager (1988 & 1989) provide a comprehensive review bf the
literature on the present status of medical findings in sex abuse
(Editor's note: Also see Lee Coleman, Medical
Examination for Sexual Abuse: Have We Been Misled?, Issues in Child Abuse
Accusations, 1989, Volume 1, Number
1 This is taken from Richard Gardner's new book,
Abuse Hysteria: Salem Witch Trials Revisited ().
* Richard A. Gardner is a psychiatrist and can
contacted at Creative Therapeutics, 155 County Road, P.O. Box R,
Cresskill, New Jersey 07626-0317.