Historical overview of scientific approaches to child sexualized abuse

Trifonova Yara Alexandrovna ORCID: 0009-0004-4860-1849 Postgraduate student of the Department of General and Applied Psychology, St. Petersburg State Pediatric Medical University 194100, Russia, Saint Petersburg, Saint Petersburg, Litovskaya str., 2 yaratrif@gmail.com

Introduction.  Sexualized violence is generally regarded as one of the strongest stressors, having consequences for both the physical and mental health of the victims ^{[1; 2]}. At the same time, it is noted that children and adolescents are one of the most vulnerable groups, and many of the people who have been subjected to sexualized violence first encountered it before reaching adulthood ^[3]. Therefore, and also in connection with the highly estimated prevalence of sexualized violence against minors, at the moment solving the problems of violence prevention and assistance to victims is a priority both from a practical and scientific point of view. ^{[4; 5; 6]}.

However, the attention of the academic community and the general public to the sexualized abuse of minors has repeatedly increased and weakened during different historical periods. Thus, the periods of greatest concern can be noted at the end of the XIX century, in the modernist era of the beginning of the XX century and at the end of the XX-beginning of the XXI century ^{[7; 8; 9; 10]}. At the same time, in each of these epochs, this phenomenon was, as it were, "rediscovered": beliefs about sexualized child abuse as such, perceptions of victims and perpetrators, predictors and consequences of violence have changed. Therefore, in order to understand the fundamental problems and challenges of our time, it is important to review the evolution of approaches to the problem of sexualized violence against minors.

The emergence of a scientific view on the problems of sexualized child abuse: a medical perspective and the first theories of psychoanalysts.

In the period from the middle of the XIX to the beginning of the XX century, the leading role in the study of violence belonged to the work of medical and forensic experts. The so-called "medical paradigm" of sexualized child abuse prevailed, in which it was understood, as a rule, as an exclusively violent penetrative act, and the main task of experts was considered to be the search for objective evidence of the crime committed. Thus, the first published work on the sexualized abuse of children appeared in France already in 1857 – it was the work "Medical and legal studies of sexual violence" (Etude M?dico-L?gale sur les Attentats aux M?Urs) Auguste Ambroise Tardieu, a famous French pathologist and a pioneer of forensic medicine, – however, public interest in this problem fluctuated significantly until the beginning of the XX century ^[11].

It should be noted that the effect of the influence of the medical paradigm is considered by modern analysts of history as ambiguous ^{[12; 13; 14]}. On the one hand, the establishment of a medical paradigm made it possible to strengthen the evidence base in cases of sexualized violence and contributed to bringing criminals to justice. On the other hand, it was the focus of experts on detecting physical traces of violence (which was not always possible) that often caused doubts about the veracity of the testimony or discrediting the victims as having "voluntarily" entered into sexual relations.  For example, according to the historical analysis of C. Cage, in the French legal system, the moral, physical and social appearance of the victims played a leading role in the imposition of convictions or acquittals throughout the XIX century ^[12]. Physically developed children and children from socially disadvantaged segments of the population were more likely to be accused as "prematurely spoiled" or "provoking", and in the case of physical signs of molestation (such as infection with STDs, damage to the hymen or genital injuries), they were usually interpreted not in favor of the child: as a consequence of the presence of he has an early sexual experience, and not as proof of the violence committed against him. In addition, since the main task of the experts was to protect the suspect from false accusations, and the myth of "blackmailing children" was extremely strong, psychiatric examinations of that time were replete with assumptions about child falsehood, parental collusion, selfish motives in accusing or even simulating violence by a child. Thus, neither verbal evidence nor physical signs could be considered reliable evidence of committed violence, which significantly hampered both real prosecutions and the formation of theoretical awareness of society and experts about sexualized child abuse.

The starting point of a serious consideration of the verbal evidence of victims in the framework of a scientific approach to the study of sexualized violence against minors is considered to be the emergence of interest in this problem in psychological science, which occurred at the end of the XIX century due to the presentation by Sigmund Freud of his "theory of seduction" ^{[15; 16]}.

This theory is based on the idea that early sexual impressions are the main cause of neurotic symptoms. At the same time , in his works and speeches of that period , Z. Freud noted the amazing frequency of presenting information about incest between father and daughter, and when faced with criticism from colleagues, he always defended the truthfulness of these memories, citing as arguments the reluctance of clients to recall traumatic scenes, their reaction to suggestion, the consistency of traumatic events with the rest of the medical history and their independent confirmation, as well as the similarity of details in the stories different clients and therapeutic success following the disclosure of information about the injury ^[17].

However , later Z. Freud, abandoning the theory of seduction in favor of the theory of infantile sexuality (in particular, the Oedipus complex), advocated an intrapsychic, internal etiology of mental illness, and not for the recognition of the traumatism of the environment. Without completely refuting the assumption that violations may arise under the influence of seduction, he, however, argued: "... [in his previous works] I overestimated its frequency or significance. [...] It goes without saying that seduction is not required to awaken the sexual life of a child, and such awakening can occur spontaneously for internal reasons" ^{[18, pp. 96-97]}.

In other words, the reason for the development of "hysteria" was considered not so much seduction on the part of an adult, as the suppressed desire of patients to enter into incestuous relationships with their fathers or mothers. The abundance of psychoanalytic material associated with traumatic memories of incest was explained by the influence of unconscious fantasies and the work of mental defenses that transform memories of how a child practiced sexual acts independently (child masturbation) into incest pictures ^{[18, pp. 151-155]}.

In the future, the theory of seduction was reinterpreted in various ways in the works of other psychoanalysts. Thus, one of Sigmund Freud's colleagues and confidants, Karl Abraham, hypothesized the existence of a "traumatic diathesis" – a constitutional predisposition of some children to provoke sexualized violence against themselves, which, from his point of view, could explain both the frequent recurrence of sexual trauma in adulthood and the neurotic or concomitant trauma of such a trauma. psychotic symptoms ^[19]. In other words, the pathological symptoms were considered by K. Abraham not as a consequence of trauma, but as one of the constitutional features inherent in children with "traumatic diathesis". At the same time, he noted that sexualized violence can also be carried out against children who do not have a "traumatic diathesis", but the reaction of such children to the fact of violence will be different: having no impulses of shame and guilt caused by their own sexual activity, these children will talk about the incident freely, and their reactions to trauma will not include displacement or stealth.

Another well-known psychoanalyst, S. Ferenczi, also argued with Z. Freud on the rejection of the theory of seduction. But, unlike K. Abraham, he considered as the cause of subsequent disorders not the characteristics inherent in the child, but the work of the mechanisms of the psyche, plunging the victim of "seduction" into a traumatic fixation on neurotic experiences. So, according to the concept of Sh. Ferenczi, the language of expression of love in the parent-child relationship is the "language of tenderness", while in the partnership between two adults, the "language of passion" dominates. And in the case of sexual assault on a child by an adult, there is a "confusion" of these two languages, which gives impetus to the premature maturation of certain parts of the child's personality and, as a consequence, some splitting of his personality ^[20].

Thus, the period of studying sexualized violence against minors in the XIX and early XX centuries is characterized by two main scientific perspectives: medical and psychoanalytic. At the same time, it is important to note that these perspectives complement each other both in their strengths and in their weaknesses.

On the one hand, the abundance of objective expert evidence of violence leads to the fact that sexualized violence against minors for the first time goes beyond the "private case" in the perception of scientists, and becomes a "disease of society", which prompts interest in it from psychiatrists and psychologists. On the other hand, the widespread establishment of a medical paradigm rejecting the oral testimony of children as evidence (and, due to the lack of development of medicine at that time, not always able to find irrefutable evidence of violence at the physical level), did not fully meet the interests of protecting children. A natural consequence of the spread of the myth of a lying, "blackmailing" child was the shifting of guilt or part of it from the perpetrator to the victim, often by searching for real or imaginary flaws. As a result, a number of mental health specialists also adopted a pathologizing view of the victims: the image of the child often appeared distorted, in the form of "excessively spoiled", "mentally unhealthy" and "contributing to crime" (or unintentionally "provoking crime" due to a combination of certain individual mental traits, as, for example, in the above-mentioned theories of K. Abraham) ^{[12; 19]}

Thus, an active research interest in sexualized violence against minors in the XIX-early XX century led to the emergence of scientific debates about the role of the child himself in what happened to him, which formed the basis of scientific and public discourse in the subsequent historical period.

Social interpretation of the problem of sexualized violence against minors: the sexualization of victims, the accusation of mothers and feminist theories.

By the beginning of the twentieth century, secualized violence against children is increasingly recognized as a fairly common problem, which leads to the search for its "social" roots.

The idea of a child as a "sexual being" embedded in the works of Z. Freud and other researchers continues to develop, and experts in the field of psychological and physical health increasingly agree that sexuality is part of the normal development of a child ^{[21; 22]}. Researchers of this period, as a rule, stood on the positions of "sexual modernism": freedom of sexual expression and the harm of its suppression (including for children and adolescents) ^{[9; 22; 23]}. At the same time, thanks to their work, the idea of a child as an innocent being is gradually being lost, and some experts suggest that sexual contacts with adults are harmless or even desirable for children.

Thus, psychoanalysts L. Bender and A. Blau wrote in 1937: "...we often considered the possibility that a child could be a real seducer rather than an innocent seducer" ^{[24, p. 514]}. At the same time, their research position is that sexual experience with adults had minimal negative consequences for children.

P. Sloane and E. Karpinski, in their study of the consequences of incest relationships that began in adolescence or childhood, present a similar point of view. According to them, "the traumatic aspect loses some of its significance when it is realized that the child himself often unconsciously desires a sexual act and becomes a more or less voluntary participant in the action" ^{[25, p. 666]}. In addition, in their discussions about the mechanisms of incest, a large role is assigned to the personality of the victims. Thus, analyzing the five cases of molestation of girls by older family members cited by them, the authors write: "... the factor that probably played a role was the weakness of the Ego [in girls] in combination with a possible abnormal craving for sexual arousal, which primarily led to incest" ^{[25, p. 673]}.

A. Kinsey, recognizing the high prevalence of sexualized violence against minors and not focusing on the specific features characteristic of the "seductive child", nevertheless, also departs in his analysis from criticism of the figure of the rapist, contrasting it with the figure of public opinion. In his work "Sexual behavior of a female human" he writes: "It is difficult to understand why a child, with the exception of cultural conditioning, should feel anxiety when touching his genitals, or anxiety at the sight of another person's genitals, or anxiety at even more specific contacts [...] Some of the more experienced researchers of juvenile problems believe that the emotional reaction of parents, police officers and other adults who found out that a child had such contacts may bother the child much more than the sexual contacts themselves" ^{[26, p. 121]}.

Thus, within the framework of the victim-sexualizing approach, the main tendency was to highlight the "provoking" features of a child who has been subjected to sexualized violence, as well as to mitigate or deny its negative consequences for the child's psyche.

Another trend, also avoiding the focus on the perpetrator, was the popularization of the "conspiracy theory", which was widely used to describe the role of the mother in the development of sexualized domestic violence. At the same time, "collusion" was understood as both conscious and unconscious denial by the mother of the fact of violence ^[27].

"Incestuogenic" mothers are described in the literature as having their own unsatisfied desires of an oedipal nature, which they realize by indulging incest between a spouse and daughter, and/or refusing the social role of wife and mother (which, in the view of proponents of this theory, facilitated the daughter's entry into incest by assuming the maternal role) ^{[28; 29; 30; 31]}.

However, in the 1970s there were significant changes in the understanding of sexualized violence both by society as a whole and by individual specialists in the field of clinical medicine and psychology. Many authors note the role of the second wave feminist movement in rethinking sexualized violence (in particular, sexualized violence against minors) as a crime and social problem ^{[32; 33; 34; 35]}. 

Florence Rush, a social worker and researcher, is often singled out as one of the earliest and most influential authors who launched a wave of a pro–feminist approach to the study of sexualized child abuse, who for the first time presented an extensive analysis of incest cases from her practice with an emphasis on the ubiquitous nature of the problem and the innocence of victims ^{[37; 42]}.

In the book "The Best Kept Secret", F. Rush considers sexualized violence not as an isolated crime or psychopathology, but as a natural consequence of the social permissibility of attacks on the bodily integrity of women and girls in general. "The molester," she writes, "is not a product of a dysfunctional or dysfunctional family and can be as normal or abnormal as the rest of the so–called normal men" ^{[38, p. 2]}. F. Rush draws a relationship between child pornography, child prostitution, child rape and such "everyday" phenomena as street harassment. and harassment, harassment in public transport, cinemas, etc., focusing on the ordinariness and prevalence of various forms of sexualized assaults on minors ^[38].

In his other work, "The Freudian coverup", F. Rush also focuses on the ubiquity of sexualized violence against minors (and in particular incest). At the same time, the author emphasizes that the high prevalence of this problem has already been discovered by Z. By Freud a few decades earlier. However, his rejection of the initial conviction in the truth of the stories of his patients and departure from the "theory of seduction", according to F. Rush, contributed to the further silencing of the problem for many decades ^[39].

After the "rediscovery" of the problem of sexualized child abuse, the number of research and journalistic works on this topic began to grow. In addition to publications and reports , F. Rush, among the most significant feminist studies of that period mention "Kiss Daddy Goodnight" by Louise Armstrong (1978), "Betrayal of Innocence" by Susan Forward and Craig Buck (1978), "Conspiracy of Silence" by Sandra Butler (1978), "Incest of Father and Daughter" by Judith Herman (1981) and many others ^{[35; 40]}.

Thus, thanks to her growing influence, the feminist literature of the 1970s and 1980s formed a new optics in the analysis of this problem. Based on various works devoted to the consideration of this optics, it is possible to distinguish several characteristic features for it. Thus, an important feature of feminist discourse was the demarginalization of sexualized violence (especially incest), the emphasis on a wide range of "normal" families in which this happens, and the horrifying ordinariness of the phenomenon itself ^{[32; 33]}. Another distinctive feature was the rejection of the traditional "expert" psychological and psychiatric approach in favor of the formation of psychotherapeutic groups (including "self-help groups") and the provision of social support: the creation of helplines, the opening of crisis centers, voluntary support of victims in interaction with the police, the development of self-defense programs for girls, etc. ^{[40; 41]}.

Thus, the debates of the XX century, which took place within the framework of the formation of the social paradigm of the analysis of sexualized violence against minors, can be considered as a transition from the construction of a "contributing victim" to the construction of an "innocent victim" and from the view of sexual activity as harmless to the child and even capable of bringing him pleasure – including in the context of relationships with adults – to view any sexual contact between adults and children as a violent act that violates the natural boundaries of the child.

However, it should also be noted that within the framework of the feminist approach, the concept of "women and children" was one of the main ones – that is, sexualized violence against children was considered only as one of the forms of rape, which is the result of the general patterns of patriarchal oppression ^[35].

This approach, on the one hand, made it possible to organize the above–mentioned complex interventions aimed at supporting different ages, but on the other hand, it deprived sexualized violence against children of specific features, reducing it to one of the diverse systemic manifestations of male dominance over women.

Partly for this reason, and partly due to the lack of universal recognition of the "theory of patriarchy" (which was not a scientific theory in full – rather, a political or ideological system), attempts to conceptualize sexualized violence against children and to prove its inadmissibility from other, not only feminist positions, were continued ^[42].

Sexualized child abuse as a moral and ethical problem is the basis of the modern approach to the protection of victims.

As an example of one of the first works dealing with the moral significance of sexual contact with minors, one can cite the well-known article by sociologist David Finkelhor "What is wrong with sex between adults and children? Ethics and the problem of sexual abuse" ^[43]. Bringing counterarguments to such widespread arguments against sexual relations with children as their unnaturalness from a biological point of view, asexuality of children and possible damage, he argues: there are many socially acceptable types of sex that do not lead to reproduction, children have sexuality and explore sexual relations with each other, and the empirical basis of the argument "against harm" can be broken when there is evidence of positive experience. Nevertheless, the author firmly stands on the position of the prohibition of sexual relations between adults and children, justifying it through the concept of true consent. "The key argument is that children by their nature are not capable of giving true consent to sex with adults," he writes ^{[43, p. 694]}. According to D. Finkelhor, in order for consent to be considered true, a child would have to not only have complete information about what he agrees to (and be able to realize it), but also have true freedom of choice – that is, not to be under the authority of an adult at all, which is impossible due to the fundamental asymmetry of relations between them.

In the modern view of the problem of sexualized violence against children, the concept of "true consent" – that is, informed and obtained without using the unconditional power of an adult over a child – is becoming quite widespread. For example, in a critical review of the literature on the moral status of sexual relations between adults and minors, A. Mal?n cites three arguments most often used by experts to condemn: possible harm, exploitation of a child by adults due to their inequality and the inability of a child to give valid consent (due to the limitations of his civil rights in general) ^[44]. It should be noted that the last two arguments obviously echo the idea of "true consent". Other authors argue in a similar way, postulating that in relation to sexual contacts with adolescents, the argument of "cognitive inability to consent" may not be entirely true, but the argument associated with the abuse of inexperience or exploitation by an adult partner of the obvious hierarchy between him and the teenager remains valid ^{[36; 45]}.

Thus, it is the "truth" of consent that becomes the dominant criterion for the inadmissibility of sexual interaction with minors, which implies the idea of the need to protect them from attacks.

And, although at present the debate about the sexuality of children and adolescents and ways to implement it cannot be considered fully completed, the position of unconditionally classifying any (including "nonviolent") sexual contacts between them and adults as abusive is leading in the academic environment, and socio-public and expert work to improve prevention and response measures the situation of sexualized violence against minors continues ^{[46; 47]}.

However, speaking about the need to protect minors from encroachments, modern specialists face not only practical, but also fundamental challenges.

Thus, the very image of the injured child has undergone significant changes as the above-described academic debates have developed. If the period of the XIX-early XX century was characterized by the idea of an "ideal victim" (completely innocent, but injured) and a "provoking victim" (contributing to a crime or having attractive features for a criminal), then thanks to feminist gender studies of the twentieth century, the idea of a "helpless victim" was formed – unable to protect herself from- for the all-encompassing power of the rapist over her. However, none of these images fully meets the actual needs of the victims. For example, in his historical analysis of narratives about sexualized abuse of minors, S.V. Hunter notes that, although initially the discourse of "victims" arose precisely as a result of upholding the innocence of victims, the term "victim" was also associated with ideas about the powerlessness, passivity and vulnerability of victims, he assumed the victimization of the entire personality. Therefore, by the 1980s, opinions appeared about the stigmatizing role of this discourse, and it was replaced by the discourse of "survivors" - that is, survivors of tragedy, who went through childhood adversities and became stronger due to the experience of overcoming trauma ^[48].

In a number of works, indeed, there is evidence that the refusal to define oneself as a "victim" (in favor of a "survivor") can be therapeutic for victims ^{[49; 50]}. However, the discourse of "survivors" has its drawbacks: focused more on overcoming than on support, it emphasizes the individual responsibility of survivors for healing, without emphasizing sexualized violence as a problem requiring a public solution ^[51].

As a neutral term, some authors propose the definition of "survivors of sexual violence" as speaking about experience, but not about personality ^[52], or the term "victim-survivor" as inclusive for different categories of victims ^[53].

Thus, within the framework of the modern approach to the protection of victims, it seems important to pay attention not so much to the social construction of an image (corresponding to the "ideal victim" or "survivor" winner), as to the construction by the victims (including with the help of helping specialists) of an image for themselves, their subjective self-determination and the formation of an identity that will integrate the traumatic experience into a holistic image of the "I".

Equally important for determining the further vector of development of measures to protect victims is the formation of a clear model of the consequences of sexualized violence against minors. Currently, the most widely known sets of consequences are "post-traumatic disorder" (or "post-traumatic disorders") and "post-traumatic growth". In accordance with these categories, in modern intervention programs, it is also customary to distinguish two main approaches: an approach based on the ideas of experiencing the experience of violence as something that provokes the occurrence of negative consequences and leads to a "deficit" - a pathogenic approach; and an approach based on the prospects of possible personal growth after successfully overcoming a traumatic experience, gaining "strengths" ("strengths") – a salutogenic approach ^{[54; 55; 56; 57; 58; 59]}.

At the same time, it is important to note that both approaches, as well as the various assistance strategies that follow from them, have their advantages and disadvantages ^[60].

The first approach, which includes programs based on cognitive behavioral therapy, has many documented studies of its effectiveness. The main purpose of such interventions is to reduce the symptoms of trauma and improve functioning by changing cognitive distortions and dysfunctional behaviors that can be observed in both minors and adult victims ^{[60; 61; 62]}. However, the lack of consensus in determining the symptoms and mechanisms of trauma development makes it difficult to use any of the existing models for conceptualizing the psychological consequences of sexualized violence against minors as a basis for developing a single "helping approach". The goal of the second approach is not correction, but personal development: the opportunity to enter into the process of growth after a trauma with the help of interventions. Proponents of this approach claim that it promotes not just "healing", but also a positive transformation of the personality. However, in terms of its evidence base and the development of practical intervention methods, this approach is significantly inferior to the previous one ^{[63; 64]}.

Thus, the current situation in the field of research and development concerning sexualized violence against minors remains quite problematic, since the lack of universal ideas about violence as such, its possible consequences and the image of victims can significantly hinder the formation of a unified approach in the work of helping specialists. At the same time, the "fragmentary" view of the problem, characteristic of the currently used approaches, as described above, has its drawbacks. In addition, the diversity of views on algorithms for providing assistance to victims can lead to controversial assessments of these interventions ^{[65; 66]}, as well as the inability to fully cover the specific consequences of trauma within existing approaches and insufficient effectiveness of therapy in relation to individual symptoms ^[67], which can lead to delayed emergence of problems in adults ^{[68; 69]}.

Therefore, in order to determine the strategy of practical assistance to victims, it is important to solve fundamental problems, to develop a unified professional view of sexualized child abuse and its consequences. In connection with this need , the following problematic issues arise:

1.                   The question of conceptualizing the consequences of sexualized violence against minors: what are the main symptoms and mechanisms of their development, and how can "post-traumatic disorders" and "post-traumatic growth" correlate in the clinical picture of trauma?

2.                   The question about the paradigmatic ethical foundations of helping interventions: what are the possibilities of resolving the "victim/survivor" dichotomy, which terminology in relation to victims of sexualized violence will be the most correct and will remove the stigma, but keep the emphasis on the need for support?

Based on these issues, the following topical areas can be identified in the field of fundamental research of sexualized violence against minors, which will allow us to develop a single vector for the further development of the approach to the protection of victims:

1. Development of a unified model for conceptualizing the consequences of sexualized violence against minors (which may include both symptoms of "post-traumatic disorders" and manifestations of "post-traumatic growth").

2. Development of paradigmatic ethical foundations of helping interventions, focused not only on efforts to adopt a consensus on the inadmissibility of violence, but also on developing a correct approach, taking into account the actual request of victims for assistance and support, on the one hand, and the absence of social stigmatization as "victims", on the other.

Conclusion.

Summing up the above, during the evolution of scientific approaches to the problem of sexualized violence against minors, many changes have taken place in academic circles and in public opinion in general. Thus, the period from the nineteenth to the twentieth century was characterized by a transition from the medical paradigm to the social one and from the dominance of psychoanalytic theories to the scientific debate between sexual modernists and the feminist movement, and the end of the twentieth century outlined trends towards the dominant concept of "true consent" to this day, which led to a relative consensus on the inadmissibility of sexual relations with minors.

At the same time, within each of these periods, an essential role of the social, cultural and political context is noted in constructing the image of the victim (as a "contributing victim", "innocent victim" or "not a victim, but a survivor") and the formation of various approaches to determining the origins of sexualized violence and interpreting the experiences of those who encountered it.

Currently, the leading trends in the approach to the protection of minors are focusing on their psychological well-being and granting them the basic right to inviolability. At the same time, there are different views on the trauma of sexualized violence – as a pathological condition and as a crisis that can lead to further growth – and the role of this experience in determining the identity of the victim – as victimizing, heroizing or relating to the event, but not the person as a whole.

Thus, there remains a need to form universal ideas about sexualized violence against minors, conceptualize its possible consequences and develop ethical paradigmatic foundations for interventions aimed at preventing sexualized violence against minors and helping victims.