C/u/d Ahuse & h’e&/. Vol. 15, pp. 597-600, Printed in the U.S.A. All rights reserved.
1991 Copyright
BRIEF
CHILD
SEXUAL TING-PONG
014%2134/91$3.00 + .oo 0 1991 Pergamon Press plc
COMMUNICATION
ABUSE
IN HONG KONG
Ho AND WAI-MING
KWOK
Department of Psychiatry, University of Hong Kong Key Words-Child
sexual abuse, Hong Kong, Sociocultural aspect.
INTRODUCTION DESPITE GROWING CONCERN and intense research in child sexual abuse in the West for the past two decades, similar enthusiasm is unheard of in Chinese or Asian societies. The extent of the problem reported in the West is a serious one. In the United Kingdom the annual incidence rate has been reported to be 0.3 per 1,000 children (Mrazek, Lynch, & Bentovim, 1983); and the prevalence rate 12% for females, 8% for males (Baker & Duncan, 1985). In the United States, corresponding figures were 0.7 per 1,000 children (NCCAN, 198 1); 6-62% for females and 3-3 1% for males (Finkelhor, 1986). Across different ethnic groups, the prevalence rates were found to be similar for Afro-Americans (Wyatt, 1985), higher for Hispanics (Kercher & McShane, 1984), and lower for Asians and Jews (Russell, 1986). The basis for such ethnic differences is poorly understood. A Medline search of the literature from 1984 to 1990 did not reveal a single publication on child sexual abuse in Chinese populations. Two papers touched on this issue indirectly: Kok (1984) described three cases in Singapore of parasuicides who were sexually abused in their childhood. Law (1979) reported 155 cases of child molesters in a lo-year period in Hong Kong. A total of 165 girl victims and 18 boy victims were involved. Over half (56%) of the victims were either casual acquaintances or strangers to the offenders. In 1989, only four cases of child sexual abuse were recorded by the child protection services unit of the Social Welfare Department and one case by the Against Child Abuse Agency ( 1989). Both agencies are official organizations whose sole function is the management of child abuse cases for the whole territory of Hong Kong. Less than ten cases were identified in the past ten years in the child psychiatry unit of Queen Mary Hospital, a regional general hospital serving a local population of 1.5 million. In this paper we report three sexually abused Chinese children in Hong Kong and explore the sociocultural factors that relate to the apparent rarity of the problem.
Received for publication July 20, 1990, final revision received October 17, 1990; accepted October 18, 1990. Requests for reprints should be sent to Dr. Ting-Pong Ho, Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Hong Kong. 597
598
Ting-Pong Ho and Wai-Ming Kwok
CASE REPORTS
Patient 1 W.L. was a 13-year-old girl whose parents separated when she was aged 2. Her custody was assigned to the father, whereas that of her younger sister was granted to the mother. She was cared for by various caretakers until aged 8 when she returned to live with her father. The father, aged 43, an unskitled laborer, was a socially isolated person who spent most of his time after work with his daughter. His relationship with the girl was intimate, and there was a strong mutual emotional dependence. One day when the girl was punished by her schoolteacher, she broke into tears and disclosed that against her will she had been forced by her father to engage in sexual activities since she was 8. The activities included sharing the same bed, reading ~mo~phic materials, nudity, kissing, fondling of breast and genitalia, and oral sex but no vaginal intercourse. The activities occurred almost daily, and she had kept the secret for five years. The disclosure was reported by the schoot guidance officer to the Social Welfare Department. and the girl was subsequently admitted into hospitai. No gynecological abnormality was found. Mentally, the girt was not depressed. though she expressed anger towards her father and wished to go back to age 5 or 6 when she was living a happy life. In a multidi~iplina~ conference, a case of sexual abuse was established. The girl was placed in a home for women and followed up by social workers.
A.F., a 7-year-old boy studying in Primary 3, was brought to the attention of his teachers because of deteriorating academic performance and daydreaming during lessons. In the interview with the school guidance olhcer, the child revealed a history of sexual exploitation by his father for three years. The police were informed, and the child was sent to hospital for medical and psychiatric assessment. The boy was the only child in the family. His father worked as a porter, and his mother was a part-time factory worker. Both came from a large traditional family, and they were essentially illiterate. The family of three lived in a 200-square feet public housing unit. Three years earlier the father had noticed patches of skin lesions over his groin and thought he had contracted venereal disease, though he did not know how and why he got it. His wife shared the same opinion. The marital relationship deteriorated, and they stopped having sex. The father felt too embarrassed to seek medical treatment; the skin lesions waxed and waned. Masturbation to reheve sexual tension was not attempted because he believed that such practice was morally wrong and was det~men~ to his health. Instead he asked his son to sleep with him. He fondled and squeezed the child’s genitalia, pinched his buttocks, and kissed his face or mouth. This happened almost daily and each time lasted up to an hour. The child was very much annoyed by the repeated disturbances but would be beaten when he refused. The mother was fully aware of these activities, but she was powerless to stop her husband. On assessment, the child’s IQ was found tobe borderline subnormal. The father was not found to have homosexual or pedophilic tendencies. Sexual abuse was established in a muitidisciplin~ case conference, and a Care and Protection Order was apptied. The father’s skin problem was diagnosed to be a fungal infection, and it responded to treatment. The child was allowed to return home. The family agreed to receive therapy from a social worker and psychjat~st.
Patient 3 O.L., aged 8, is the only child of the family. She was put under foster care when her mother, because of marital discord, deserted the family. The father, aged 39, worked as a barber. He took the child home on weekends. One day the girl complained of pruritus over her genital region, and the foster mother found yellowish secretions on her underwear. Upon further inquiry, the child reveafed that during weekend home leave her natural father frequently fondled her private parts. The case was reported to the social welfare department and the police. Subs~uently the child was examined by a forensic pathologist who found that there was an incomplete tear of the hymen. The child gave a consistent account of the sexual molestation by her father, but this was denied by him. In a multidisciplinary conference this was established as a genuine case of sexual abuse. The girl was assigned to long-term
Child sexual abuse in Hong Kong foster care. She became a ward of the social welfare department, visits to his daughter.
and under supervision
599 the father was allowed limited
DISCUSSION These three reported cases of intrafamilial child sexual abuse differ in no remarkable ways from those reported in the West. However, the low local reported rates are in contrast to the high prevalence rates in the West. The topic remains a taboo locally, and disbelief is a common reaction. Concrete evidence such as direct allegations of older children and physical signs are often required to alert workers. Thus allegations from young children and masked presentations are easily missed. The low level of awareness in professionals may account for the apparently low incidence. Even in identified cases, high secrecy is a common factor. In Cases 1 and 2, the children were subjected to years of abuse before discovery. In Case 3, the vaginal discharge alerted the foster parents. Shame and complicating family dynamics associated with incest form a vector favoring secrecy. This may be particularly so among the Chinese. Traditional Chinese tend to contain shameful secrets within family circles more than Western families. Similar trends of tolerance and containment can be found in response to physical illness (Kleinman, 1980) and mental illness (Lin, Tarditt, Donetz, & Goresky, 1978). The Chinese pattern of child rearing is characterized by an initial period of permissiveness followed by strict discipline and a demand for unquestioned obedience (Ho, 1981). Filial piety is the prime guiding principle for socializing children and gives justification for the absolute authority of parents over children. In Chinese children’s stories (for example, the classic 24 stories of filial piety), defiance of parental authority results in the admonition, punishment, or death of the transgressor (Tseng & Hsu, 1972). This attitude may facilitate the use of children as sexual objects for adult gratification. When sexual abuse does occur, especially in intrafamilial cases, the subordinate position of children may make disclosure difficult and adults less receptive; thus revelation is more difficult, and there is an apparently low incidence. The generally quoted lack of overt affectionate expression within family circles (Ho, 1972) and marked suppression of sexuality in children (Singer, Ney, & Lieh-Mak, 1978) may possibly lead to confusion and blurring in various shades of affectionate relationship in Chinese children. Children, therefore, do not easily have the words or differentiating ability to talk about their experiences of being sexually abused. On a social level, the taboo of incest among Chinese is a particularly strong one. Marriage to one’s kin or person bearing the same surname (presumed to be descended from a single patrilineal ancestor) is prohibited among traditional Chinese. The tremendous disgrace following the disclosure of incest is often compounded by intense interest by the local media. The absence of a family court and trained police personnel to deal with such cases are factors that inhibit professionals from reporting such incidents.
REFERENCES Against Child Abuse Agency. (1989). Against child abuse annual report (1988-1989). Hong Kong: Author. Baker, A. W., & Duncan, S. P. (1985). Child sexual abuse: A study of prevalence in Great Britain. Child Abuse &
Neglect, 9, 457461. Finkelhor, D. (1986). A sourcebook on child sexual abuse. Beverly Hills: Sage. Ho, Y. F. (1972). The affectional function in contemporary Chinese families. Proceedings ofthe 24th AnnualMeeting of the World Federation for Mental Health (pp. 13 I-1 37).
600
Ting-Pong Ho and Wai-Ming Kwok
Ho, Y. F. (I 98 1). Traditional patterns of socialization in Chinese society. Acfu Psychologicu Tuiwanicu, 23(2), 8 1-95. Kercher, G. A., & McShane, M. (I 984). The prevalence of child sexual abuse victimization in an adult sample of Texas residents. Child Abuse & Neglect, 8, 495-501. Kleinman, A. (1980). Patients and healers in the contexf of culture. Berkeley, CA: University of California Press. Kok, L. P. (1984). History of incest in a parasuicide population in Singapore. Auslruliun and New Zealand Journal of Psychiatry, 18, 188-190. Law, S. K. ( 1979). Child molestation: A comparison of Hong Kong and western findings. Medicine, Science andlaw, 19(I), 55-60. Lin, T. Y., Tarditt, K., Done&, G., & Goresky, W. (1978). Ethnicity and patterns of help seeking. Culture, Medicine, and Psychiatry, 2, 3- 13. Mrazek, P. J., Lynch, M. A., & Bentovim, A. (1983).Sexual abuse ofchildren in the United Kingdom. ChildAbuse & Neglect, 7, 147-153. National Center on Child Abuse and Neglect (NCCAN). (198 I). Studyfindings: National study of incidenceand severity of child abuse and neglect. Washington, DC: Department of Health, Education and Welfare. Russell, D. E. H. (1986).The secret trauma. New York: Basic Books. Singer, K.. Nev. P. G.. & Lieh-Mak, F. (1978). A cultural perspective on child psychiatric disorders. Comprehensive fiychiuiry, i9(6), 533-540. Tsena. W. S.. & Hsu. J. (1972). The Chinese attitude towards parental authority. as exuressed in Chinese children’s sto:es. Archives oiGeneral ksychialry, 26, 28-34. Wyatt, G. E. (1985). The sexual abuse of Afro-American and white American women in childhood. Child Abuse & Neglect, 9, 507-5 19.
1991 Copyright
BRIEF
CHILD
SEXUAL TING-PONG
014%2134/91$3.00 + .oo 0 1991 Pergamon Press plc
COMMUNICATION
ABUSE
IN HONG KONG
Ho AND WAI-MING
KWOK
Department of Psychiatry, University of Hong Kong Key Words-Child
sexual abuse, Hong Kong, Sociocultural aspect.
INTRODUCTION DESPITE GROWING CONCERN and intense research in child sexual abuse in the West for the past two decades, similar enthusiasm is unheard of in Chinese or Asian societies. The extent of the problem reported in the West is a serious one. In the United Kingdom the annual incidence rate has been reported to be 0.3 per 1,000 children (Mrazek, Lynch, & Bentovim, 1983); and the prevalence rate 12% for females, 8% for males (Baker & Duncan, 1985). In the United States, corresponding figures were 0.7 per 1,000 children (NCCAN, 198 1); 6-62% for females and 3-3 1% for males (Finkelhor, 1986). Across different ethnic groups, the prevalence rates were found to be similar for Afro-Americans (Wyatt, 1985), higher for Hispanics (Kercher & McShane, 1984), and lower for Asians and Jews (Russell, 1986). The basis for such ethnic differences is poorly understood. A Medline search of the literature from 1984 to 1990 did not reveal a single publication on child sexual abuse in Chinese populations. Two papers touched on this issue indirectly: Kok (1984) described three cases in Singapore of parasuicides who were sexually abused in their childhood. Law (1979) reported 155 cases of child molesters in a lo-year period in Hong Kong. A total of 165 girl victims and 18 boy victims were involved. Over half (56%) of the victims were either casual acquaintances or strangers to the offenders. In 1989, only four cases of child sexual abuse were recorded by the child protection services unit of the Social Welfare Department and one case by the Against Child Abuse Agency ( 1989). Both agencies are official organizations whose sole function is the management of child abuse cases for the whole territory of Hong Kong. Less than ten cases were identified in the past ten years in the child psychiatry unit of Queen Mary Hospital, a regional general hospital serving a local population of 1.5 million. In this paper we report three sexually abused Chinese children in Hong Kong and explore the sociocultural factors that relate to the apparent rarity of the problem.
Received for publication July 20, 1990, final revision received October 17, 1990; accepted October 18, 1990. Requests for reprints should be sent to Dr. Ting-Pong Ho, Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Hong Kong. 597
598
Ting-Pong Ho and Wai-Ming Kwok
CASE REPORTS
Patient 1 W.L. was a 13-year-old girl whose parents separated when she was aged 2. Her custody was assigned to the father, whereas that of her younger sister was granted to the mother. She was cared for by various caretakers until aged 8 when she returned to live with her father. The father, aged 43, an unskitled laborer, was a socially isolated person who spent most of his time after work with his daughter. His relationship with the girl was intimate, and there was a strong mutual emotional dependence. One day when the girl was punished by her schoolteacher, she broke into tears and disclosed that against her will she had been forced by her father to engage in sexual activities since she was 8. The activities included sharing the same bed, reading ~mo~phic materials, nudity, kissing, fondling of breast and genitalia, and oral sex but no vaginal intercourse. The activities occurred almost daily, and she had kept the secret for five years. The disclosure was reported by the schoot guidance officer to the Social Welfare Department. and the girl was subsequently admitted into hospitai. No gynecological abnormality was found. Mentally, the girt was not depressed. though she expressed anger towards her father and wished to go back to age 5 or 6 when she was living a happy life. In a multidi~iplina~ conference, a case of sexual abuse was established. The girl was placed in a home for women and followed up by social workers.
A.F., a 7-year-old boy studying in Primary 3, was brought to the attention of his teachers because of deteriorating academic performance and daydreaming during lessons. In the interview with the school guidance olhcer, the child revealed a history of sexual exploitation by his father for three years. The police were informed, and the child was sent to hospital for medical and psychiatric assessment. The boy was the only child in the family. His father worked as a porter, and his mother was a part-time factory worker. Both came from a large traditional family, and they were essentially illiterate. The family of three lived in a 200-square feet public housing unit. Three years earlier the father had noticed patches of skin lesions over his groin and thought he had contracted venereal disease, though he did not know how and why he got it. His wife shared the same opinion. The marital relationship deteriorated, and they stopped having sex. The father felt too embarrassed to seek medical treatment; the skin lesions waxed and waned. Masturbation to reheve sexual tension was not attempted because he believed that such practice was morally wrong and was det~men~ to his health. Instead he asked his son to sleep with him. He fondled and squeezed the child’s genitalia, pinched his buttocks, and kissed his face or mouth. This happened almost daily and each time lasted up to an hour. The child was very much annoyed by the repeated disturbances but would be beaten when he refused. The mother was fully aware of these activities, but she was powerless to stop her husband. On assessment, the child’s IQ was found tobe borderline subnormal. The father was not found to have homosexual or pedophilic tendencies. Sexual abuse was established in a muitidisciplin~ case conference, and a Care and Protection Order was apptied. The father’s skin problem was diagnosed to be a fungal infection, and it responded to treatment. The child was allowed to return home. The family agreed to receive therapy from a social worker and psychjat~st.
Patient 3 O.L., aged 8, is the only child of the family. She was put under foster care when her mother, because of marital discord, deserted the family. The father, aged 39, worked as a barber. He took the child home on weekends. One day the girl complained of pruritus over her genital region, and the foster mother found yellowish secretions on her underwear. Upon further inquiry, the child reveafed that during weekend home leave her natural father frequently fondled her private parts. The case was reported to the social welfare department and the police. Subs~uently the child was examined by a forensic pathologist who found that there was an incomplete tear of the hymen. The child gave a consistent account of the sexual molestation by her father, but this was denied by him. In a multidisciplinary conference this was established as a genuine case of sexual abuse. The girl was assigned to long-term
Child sexual abuse in Hong Kong foster care. She became a ward of the social welfare department, visits to his daughter.
and under supervision
599 the father was allowed limited
DISCUSSION These three reported cases of intrafamilial child sexual abuse differ in no remarkable ways from those reported in the West. However, the low local reported rates are in contrast to the high prevalence rates in the West. The topic remains a taboo locally, and disbelief is a common reaction. Concrete evidence such as direct allegations of older children and physical signs are often required to alert workers. Thus allegations from young children and masked presentations are easily missed. The low level of awareness in professionals may account for the apparently low incidence. Even in identified cases, high secrecy is a common factor. In Cases 1 and 2, the children were subjected to years of abuse before discovery. In Case 3, the vaginal discharge alerted the foster parents. Shame and complicating family dynamics associated with incest form a vector favoring secrecy. This may be particularly so among the Chinese. Traditional Chinese tend to contain shameful secrets within family circles more than Western families. Similar trends of tolerance and containment can be found in response to physical illness (Kleinman, 1980) and mental illness (Lin, Tarditt, Donetz, & Goresky, 1978). The Chinese pattern of child rearing is characterized by an initial period of permissiveness followed by strict discipline and a demand for unquestioned obedience (Ho, 1981). Filial piety is the prime guiding principle for socializing children and gives justification for the absolute authority of parents over children. In Chinese children’s stories (for example, the classic 24 stories of filial piety), defiance of parental authority results in the admonition, punishment, or death of the transgressor (Tseng & Hsu, 1972). This attitude may facilitate the use of children as sexual objects for adult gratification. When sexual abuse does occur, especially in intrafamilial cases, the subordinate position of children may make disclosure difficult and adults less receptive; thus revelation is more difficult, and there is an apparently low incidence. The generally quoted lack of overt affectionate expression within family circles (Ho, 1972) and marked suppression of sexuality in children (Singer, Ney, & Lieh-Mak, 1978) may possibly lead to confusion and blurring in various shades of affectionate relationship in Chinese children. Children, therefore, do not easily have the words or differentiating ability to talk about their experiences of being sexually abused. On a social level, the taboo of incest among Chinese is a particularly strong one. Marriage to one’s kin or person bearing the same surname (presumed to be descended from a single patrilineal ancestor) is prohibited among traditional Chinese. The tremendous disgrace following the disclosure of incest is often compounded by intense interest by the local media. The absence of a family court and trained police personnel to deal with such cases are factors that inhibit professionals from reporting such incidents.
REFERENCES Against Child Abuse Agency. (1989). Against child abuse annual report (1988-1989). Hong Kong: Author. Baker, A. W., & Duncan, S. P. (1985). Child sexual abuse: A study of prevalence in Great Britain. Child Abuse &
Neglect, 9, 457461. Finkelhor, D. (1986). A sourcebook on child sexual abuse. Beverly Hills: Sage. Ho, Y. F. (1972). The affectional function in contemporary Chinese families. Proceedings ofthe 24th AnnualMeeting of the World Federation for Mental Health (pp. 13 I-1 37).
600
Ting-Pong Ho and Wai-Ming Kwok
Ho, Y. F. (I 98 1). Traditional patterns of socialization in Chinese society. Acfu Psychologicu Tuiwanicu, 23(2), 8 1-95. Kercher, G. A., & McShane, M. (I 984). The prevalence of child sexual abuse victimization in an adult sample of Texas residents. Child Abuse & Neglect, 8, 495-501. Kleinman, A. (1980). Patients and healers in the contexf of culture. Berkeley, CA: University of California Press. Kok, L. P. (1984). History of incest in a parasuicide population in Singapore. Auslruliun and New Zealand Journal of Psychiatry, 18, 188-190. Law, S. K. ( 1979). Child molestation: A comparison of Hong Kong and western findings. Medicine, Science andlaw, 19(I), 55-60. Lin, T. Y., Tarditt, K., Done&, G., & Goresky, W. (1978). Ethnicity and patterns of help seeking. Culture, Medicine, and Psychiatry, 2, 3- 13. Mrazek, P. J., Lynch, M. A., & Bentovim, A. (1983).Sexual abuse ofchildren in the United Kingdom. ChildAbuse & Neglect, 7, 147-153. National Center on Child Abuse and Neglect (NCCAN). (198 I). Studyfindings: National study of incidenceand severity of child abuse and neglect. Washington, DC: Department of Health, Education and Welfare. Russell, D. E. H. (1986).The secret trauma. New York: Basic Books. Singer, K.. Nev. P. G.. & Lieh-Mak, F. (1978). A cultural perspective on child psychiatric disorders. Comprehensive fiychiuiry, i9(6), 533-540. Tsena. W. S.. & Hsu. J. (1972). The Chinese attitude towards parental authority. as exuressed in Chinese children’s sto:es. Archives oiGeneral ksychialry, 26, 28-34. Wyatt, G. E. (1985). The sexual abuse of Afro-American and white American women in childhood. Child Abuse & Neglect, 9, 507-5 19.
