Endogamic Incest and the Victim-perpetrator Model Alvin A Rosenfeld, MD

\s=b\ Traditionally incest has been seen as aggressive act of a deranged adult

the

perpetrator against a child victim. While conceptualization is true for some cases of incest, it ignores the family this

dynamics and the underlying affectional neglect and deprivation that the child has experienced in

the home environment. It lead to interventions such as immediate incarceration of the perpetrator in all cases, which may cause more harm than good; furthermore, it may permit the state to provide no therapeutic services to the child. By using a more realistic conceptualization of prolonged endogamic incest, useful interventions and therapeutic plans can be designed. (Am J Dis Child 133:406-410, 1979) can

the last 15 or 20 years, society has taken increased notice of child abuse. This concern began with a commitment to save battered babies from death or inevitable maiming and has proceeded to a more general inter¬ est in the well-being of children, including physically, sexually, and emotionally abused children, as well as those who are neglected. Out of expe¬ rience with battered babies, a victimperpetrator model was derived. In this

For

From the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, Calif. Reprint requests to Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA 94305 (Dr Rosen-

feld).

conceptualization, a small, helpless, passive victim was said to be physi¬ cally brutalized, often to the point of permanent physical impairment or death, by a strong, malevolent perpe¬ trator.

The victim-perpetrator model was applied to sexual abuse. Perhaps with

the idea that sexual abusers were bizarre strangers lurking in the shad¬ ows, a concept was applied in incest in which a young child was seen as the helpless victim of a perverse and sexually aggressive adult who wished sexual satisfaction despite the child's immaturity and often resistance. Through physical force or by irresist¬ ible deception and manipulation,1 the adult imposed an unwished-for act on the helpless child. While this notion is valid for rape within the family, as for example, in many instances of a single incestuous act, it does not accurately portray some other kinds of incest. In the past five years, I have had clinical experience with over 100 people who were then or at one time had been involved in incest. They were seen in psychiatric evaluation, consul¬ tation, or long-term treatment. Others were seen in consultation to a child abuse team or as part of a supervisory relationship. Out of experience and study in this area, I have come to have a personal perspective on the subject. While this article recognizes a child's

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need to be protected from noxious external stimuli that impede growth, it will suggest that the victim-perpe¬ trator model is far too simplistic for the complex and distorted intrafamilial relationships seen in many cases of incest. Furthermore, because many people share the conviction that the model is a reflection of reality, its application can lead to destructive rather than constructive interventions and to further victimization of the child by well-intentioned legal and social service personnel. It is proposed that interventions in these cases should be based on a more thorough understanding of the incestuous fami¬ ly situation as will be described here. This leads me to propose a psychotherapeutic intervention as a first course of action rather than an exclusively punitive and legal one. THE VICTIMPERPETRATOR MODEL

There

several reasons why the model has found wide acceptance in incest cases. First, there is obviously truth in it. Since a young child is cognitively and psychosexually incapable of giving informed consent, especially to a loved and admired adult who is a family mem¬ ber, and since adults are expected to inhibit their impulses and to protect their children, the child involved must are

victim-perpetrator

be considered a victim. Second, the victim-perpetrator model describes a relationship in clear and simple terms. The model is partic¬ ularly compatible with the attitudes of dedicated child advocates. Those who were involved in the field of child abuse in the early 1960s needed to take an activist stance just to focus attention on the fact that infants were being murdered by their par¬ ents. Similarly, women have found themselves confronted with great prejudice when they asserted that most women who were raped had not been "asking for it." They accurately pointed out that the attitude that women who get raped are so victim¬ ized because they behave "seductive¬ ly" amounted to blaming the victim of a violent crime for its occurrence. However, the model derived from battered children and "rape" empha¬ sizes blame and innocence in a way that is too stark and simple for the more subtle psychological issues in¬ volved in many incest cases, and it allows people to bypass the critical and difficult analysis that must be made in assessing these cases. CONCEALED INCEST AND THE ENDOGAMIC FAMILY

From what is known, the victimperpetrator model does apply to some incest cases, but it is inappropriate for many others. In incest cases where the child is simply an unfortunate victim

a deranged adult, perhaps a psychotic parent, a demented grand¬ parent, or a pedophiliac uncle, the victim-perpetrator model is clearly applicable. But these are not among the more commonly studied types of incest. In his classic work, Weinberg2

of

described two basic types of inces¬ tuous families. In the "promiscuous" type, the family is so disorganized that the incest seems but one, almost minor, part of a situation that is chaotic and unpredictable in numer¬ ous ways. The parents in these fami¬ lies are antisocial, and they are often involved in promiscuity, alcoholism, and gross social deviancy. By contrast, in "endogamie" cases, the family has, for many years, seemed unremarkable socially. There is little history of deviance, criminality, asocial behav-

ior, school difficulty, and

so

on.

It

therefore comes as a complete sur¬ prise when it becomes known that incest has been a regular part of fami¬ ly life for a long time. This "conceal¬ ment" is the hallmark of the endog¬ amie family. All of the very serious family pathology remains within the confines of the home. Parents in endogamie families are immature and their lives are filled with personal losses, actual and psy¬ chological. They often seem unable to "mother" or to protect their children because of deficits in their own early experience. Since all family members fear separation intensely, they tacitly or unconsciously agree to maintain the appearance of an intact, "normal" family, using incest as a "tensionreducing" factor3 that helps maintain the family's tenuous stability by satisfying sexual needs within it. The child, sensitive to the precar¬ ious balance, is played on and strug¬ gles to sustain the situation, sacrific¬ ing personal desires and develop¬ mental needs. The child is "exploited"4 since she/he is not appreciated as an individual but rather is valued only as serving as a psychological "cement" for the endogamie incestuous family's

system.

Force is rarely used. Endogamie incest is not a one-time "rape," but constitutes a protracted relationship evolved over time, often beginning with fondling and progressing to intercourse years later in some cases. The relationship is distorted and "un¬ fair" because of the power differen¬ tial between the adult and child. It exerts a continuously distorting in¬ fluence on personality growth. How¬ ever, the absence of force and the slow evolution leaves the child less acutely stressed than in the "rape trauma syndrome,"5 where the attack may be sudden, without time for any sort of psychological preparation or defense. Endogamie fathers, whether their external behavior is domineering or are usually defending internally against gross immaturity, fears of homosexuality, strong unmet dependency needs, and an inability to deal with grown women. They tend to see their wives as threatening and rejecting6 and they are sexually

submissive,

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estranged from them, but they are unwilling to look to women outside of the family for sexual satisfaction because they fear adult women. Their separation fears and unmet depend¬

ency needs also make them very fear¬ ful of divorce. Some fathers then rationalize the incest by saying that adultery is more reprehensible, while others point out that their need for sex is intense, beyond that of ordinary males, or that they simply want to give their child a good introduction to sexuality. Some continue the incest

claim they longer enjoy it. These men obvious¬ ly have a deficit in their ability or willingness to suppress their inces¬ tuous desires, though their impulse

compulsively though they no

control is otherwise intact with little or no acting out in the community. The mother is quite likely to be a needful woman, insecure in her worth and femininity. She often seems less interested in sex than her husband is. Some literature7 and clinical experi¬ ence strongly suggest that despite her own parenthood, the mother often remains immature and tied to her own mother, pursuing her in a futile search for approval. Since the mother is absorbed in her own infantile needs, she easily slips into a pattern of abdi¬ cating the duties appropriate to her role in traditional families to one daughter, usually the eldest. This daughter takes over the nurturing, caretaking, housekeeping, and childrearing roles of mother, becoming a parent to the family. While mother overtly supports the daughter's ac¬ quiring the social role of mother, she may also encourage the daughter to assume the sexual aspects of that role. In many ways, the daughter then becomes a wife to her father and a mother to the family. Although the mother has frequently known about the incest, she may protect her fragile self-esteem by being "wounded" and "shocked" when it is revealed. The child is also needful and deprived. Affectional neglect may be an important predisposing factor for incest. Where the child objects to the activity, she soon becomes aware that there is no protective adult who will help interrupt it. However, where there is no pain, the child may in some

find the attention pleasurable. In many cases, the sexual aspects are but one part of an important relation¬ ship for the child. The "molesting" parent in endogamie families is often interested in the child not only as a sexual object but also in other aspects of the child's life, such as her artwork or school performance. The parent may take the child on trips and may buy her presents. In other cases, subtle or gross intimidation may be used. However, the adult is often loved, albeit ambivalently, trusted, and may, in some ways, be the more nurturant of the two parents. Fur¬ thermore, the sexual activities are usually at the child's psychosexual level of development—touching, kiss¬ ing, fondling, rarely with penetration in prepubertal children. Therefore, the child may find the activity ambiv¬ cases

alent, pleasurable on the one hand, since it is a "special" activity with an admired adult, but not right, since it often must be kept clandestine and secretive. Even when the genitals are

involved in the sexual activity, the psychological meaning of the relation¬ ships is more elementary, embodying a search for the safety, comfort, and nurturance of the good, protective mothering figure that neither the parents nor the child ever had. THE SEDUCTIVE' CHILD

The child has learned that sexual behavior is a way to gain attention from grown-ups. The behavior of these children can seem to be "seduc¬ tive" or sexually arousing to adults. Unfortunately, "seductive" is an illdefined, value-laden term that arouses the ire of those who think it affixes blame to the child. "Seductive" refers to a quality in incestuous chil¬ dren that shows itself as overt or covert behavior that stimulates sexual feelings in normal nonpedophilic adults, combined with a facility to make others feel extremely protective and interested, or peculiarly comfort¬ able. When exposed to this behavior, even experienced therapists may feel aroused or uncomfortable. If the sexually arousing behavior is not responded to by adults, the depression it seems to be defending against emerges. However, the term does not

imply that the child necessarily recog¬ nizes the sexual meaning of the

behavior in an adult way, nor does it attribute culpability for the incest to the child. This "seductiveness" represents learned behavior on the child's part. It uses sexuality and sexual arousal as a means to obtain nurturance, perhaps because, in these families, the child's needs cannot be satisfied through more sublimated channels. It is a desperate attempt to adapt to adults' desires to get needed affection. On reaching adulthood, these patients often demonstrate an unconscious compliance to others' wishes and fantasies, a response that seems to develop from this family style. Bender and Blau,8 Weiss et al,9 and Krieger et al,'" and others (including personal communications with sexual treat¬ ment abuse program counselors, San¬ ta Clara County, Calif) have noted this "charming" and "seductive" quality in children who had been molested or involved incestuously. Joseph Weiss, MD (written communication, 1978) stated that some of the more than 70 molested children he evaluated in his classic study of almost 30 years ago9 behaved in a very "seductive" manner during the psychiatric interview and then told their parents that the physi¬ cian had tried to molest them. These were the children his research group called "participant victims" of moles¬ tation as opposed to the "accidental" type. Krieger et al10 believe that simi¬ lar behavior in therapy represents testing, an attempt to discover wheth¬ er the new therapeutic situation is safe or demands the same techniques the home atmosphere had required, ie, to

get nurturance,

one

must

sexuality.

use

The fact that the child may seem to be seductive does not make her less, but rather more, a victim of exploita¬ tion. However, in this context the child is a victim of a depriving family situation rather than simply of a sexual "act" or perversion. This fami¬ ly setting, including incest, has dis¬ torted the possibility for normal personal and psychosexual develop¬ ment. Furthermore, not only is the child a victim of her family, but her parents are victims of their past,

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which is sometimes remarkably simi¬ lar to their child's present. Their past has predisposed them to use their child to fill voids in their own psycho¬ logical makeup. The parents' life histories and frequent incestuous past seem to create a defect in their parenting abilities and make them prone to expose their children to the risk of incestuous experiences.11 Thus, endogamie incest seems to be a multigenerational victim-to-victim rela¬

tionship.

INTERVENTIONS Because of the universal horror of

incest, there is a deep-seated belief that, where incest occurs, the outcome

is dire. This has led to an attitude that sanctions must be used in punishing incest. Retrospective studies of deviant populations have indicated a high frequency of incestuous experi¬ ences.1-14 The argument has then been made that incest causes severe social deviancy. Unfortunately, most such studies seem to compare a preva¬ lence of incest in a deviant population to a supposed near-zero general inci¬ dence. In as yet unpublished research, David Finkelhor, PhD (oral communi¬ cation) studied 530 female college students looking for early sexual activity with an adult. Nineteen percent (102) had had such an experi¬ ence, and 44% of those were with a family member. Among the one sixth of the population with family incomes of less than $10,000, 33% had had such severe

experience, with a higher percent¬ involving family mem¬ bers. With this high prevalence, it becomes questionable whether those patients who come to professional attention are representative of inces¬ tuous people in general, since only a an

age of these

small percentage of all incestuous seek help. Moreover, it casts further doubt on the notion that incest is the direct cause of promiscuity, drug addiction, and so on. It is there¬ fore not surprising that retrospec¬ tive1' and prospective1'1 studies of chil¬ dren with early sexual experiences, as well as clinical experience with inces¬ tuous patients in private psychiatric practice, indicate relatively "normal" adult adjustments without gross social

people

pathology.

In my opinion, there are subtle, yet highly important, deleterious effects in patients who more

come to a psychiatrist and who have a history of incest, though it is not clear whether these patients are represent¬ ative of incest victims generally. Despite frequently excellent vocation¬ al and, at times, social adjustments, people with a history of incest seem to have difficulty with intimacy and separation and they have a tendency to sexualize relationships. They also have problems with identity that are revealed in a subtle willingness to comply with a therapist's desires. But the hard reality is that at this point we

do not have evidence to determine whether some or all of the outcomes depend on factors such as family dynamics and the quality of interper¬ sonal relations in the home; nor are these questions usually taken into account when a symptom such as incest, to which all outcome is attrib¬ uted, is studied. Although no study has yet been completed comparing two groups of families with similar dynamics, one in which incest occurs and another in which it does not, Judith Herman and Lisa Hirschmann are currently studying 40 families matched in this way. In a prior small study,17 it was noted that the chief complaints, presenting problems, and diagnoses of conditions of adults who had been involved in incest as children and who came to a psychiatrist as adults did not seem to differ from those of patients who came to a psychiatrist and had no incestuous history. In the face of such poor foun¬ dation for hypothesis, the basing of punitive sanction on the deleterious effects of incest seems to be primarily an ethical and religious decision. Over the last several years, I have therefore become increasingly skepti¬ cal of interventions suggested by the victim-perpetrator model and con¬ cerned about their utility as clinical tools. They often seem to cause greater harm than good. If endogamie incest is conceptualized as "abuse" by a malicious adult, incarceration can be the entire solution, with no further services offered to the child and other family members. This solution is misguided because it fails to deal with

the distorted family dynamics that were the fertile soil in which endog¬ amie incest could occur18 and which have already distorted the child's emotional growth. If the situation is victimization by an evil perpetrator, incarceration is sensible. However, for the greater number of applications of this model, such is not the case. The abuser is usually the breadwinner. His place¬ ment in jail may leave the family, including the victimized child, desti¬ tute. Other family members may then blame the child for the parent's incar¬ ceration, alienating the child further. The incestuous child's guilt seems to be associated more with feelings about the parent's placement in jail than with the incest.11 It is common clinical opinion that most court proce¬ dures used in incest cases in this coun¬ try may be more harmful than the molestation itself. To testify against a parent under adversarial conditions in open court only exacerbates this dam¬ age. Furthermore, if the perpetrator parent, usually the father, has been the more nurturant parent, despite his perversity, and is ejected from the family, and the mother does not change her immature and depriving behavior, the child may lose both parents when the incest is disclosed. The child then becomes, in some ways, an emotional "orphan" in addition to being blamed for the situation. If the model is used to remove the child against her will, to "ensure her safety," further damage may be done. While this intervention is useful when desired by the child, it may intimate to the unwilling child that she is at fault and is being punished by being taken away from the family. Again, since the logic is that the tree will grow straight and tall in the absence of noxious influences, often no further services are offered to the child. However, in foster care some children may set up repetitions of the molesta¬ tion because, as mentioned earlier, this is the technique in which they were unwittingly trained to get affec¬ tion. Furthermore, recent data19 sug¬ gest that the effects of family dissolu¬ tion may be quite serious for the siblings uninvolved in incest who are not offered services because they

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merely "innocent bystanders." The fact that all family members have shared the same home and emotional climate is not sufficiently appre¬ ciated. were

RECOMMENDATIONS More satisfactory interventions, at least in endogamie incest, could be based on the understanding of the family dynamics just discussed that sustain it. As opposed to molestation by an outsider, all members of an endogamie family share the same living context. Because of this, it is

proposed that, in contrast to current legislation, in the future the endog¬ amie family system should be seen psychologically as a collaborative unit. Thus, all family members seem to play some role in maintaining the incest

situation. The occurrence and revela¬ tion of incest is a tragedy of family life that grows out of distorted family dynamics and prevents the opportuni¬ ty for normal psychosexual develop¬ ment. As mentioned earlier, endog¬ amie incest is a victim-victim interac¬ tion and, as such, is an exploitative relationship. In my opinion, the first approach in these cases should be a psychotherapeutic intervention, be¬ cause mental health professionals seem to be the people most skilled at dealing with enmeshed families. Some believe these can only be undertaken with the support of the court. I am not of that opinion for all cases. Thera¬ peutic interventions tailored to the individual family's style and needs might prove to be most helpful. However, funds for treatment in both inpatient and outpatient settings need to be, and often are not, avail¬ able. The importance of these issues should make the need for increased support clear. At times, the family can only be persuaded to enter therapy under threat of legal intervention. Hence, intervention may require a legal back¬ up. However, in many cases, threats are not necessary. This is preferable and should be permissible when possi¬ ble. First, mandatory reporting may make some families less willing to get help because they do not wish to have a family member incarcerated. For this reason, many accusations are

made. Second, mandatory reporting and legal intervention remove freedom of judgment from even the most experi¬ enced therapists and often places it in the hands of individuals who have fewer skills in dealing with the subtle¬ ties of this issue. This aspect of the law would be better changed to allow the professional reasonable flexibility. However, if this alteration were made and the law was not automatically involved, the therapist would have to assume a responsibility (perhaps in collaboration with children's protec¬ tive services) to make reasonably certain that the child's surroundings were acceptable. The need for an administrative role has been discussed in a prior publication for physical abuse cases,2" and this type of admin¬ istrative involvement would be helpful in incest cases.

withdrawn

soon

after

they

are

CONCLUSIONS Given this background, one can understand why there are movements in the country to abandon punitive intervention victim-perpetrator mod¬ els in endogamie incest, replacing them with more therapeutic ones, except as a last resort. This better recognizes the realities and meets the

needs of incestuous children and parents. However, all interventions and models for them seem based on limited data. As public attention focuses more on incest and as special programs are designed to deal with it, there is a desperate need for careful, reliable, and valid information on which to base public policy. Responsi¬ ble governmental agencies should be¬ gin now to give further support for this needed research. This investigation was supported in part by the Boys Town Center for the Study of Youth Devel¬ opment at Stanford University, Stanford, Calif,

and the Golden State 76ers Wheelchair Athletic Association. Prof Michael Wald, LLD, gave suggestions on this article. Other assistance was provided by Helen Abrahamson, MA; Thomas Anders, MD; Wenda Brewster, MA; Sheldon Levy; and Douglas Oliver, MSW.

References 1. Burgess AW, Holmstrom LL: Sexual trauma of children and adolescents. Nurs Clin North Am 10:551-563, 1975. 2. Weinberg SK: Incest Behavior. New Jersey, Citadel Press, 1955. 3. Lustig N, Dreser J, Spellman S, et al: Incest. Arch Gen Psychiatry 14:31-40, 1966. 4. Galdston R: Dysfunctions of parenting, the battered child, the neglected child, the exploited child, in Modern Perspective in International Child Psychiatry. New York, Brunner/Mazel Inc, 1971, vol 3, pp 571-588. 5. Burgess AW, Holmstrom LL: Rape trauma syndrome. Am J Psychiatry 7:500-518, 1974. 6. Cavallin H: Incestuous fathers: A clinical

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report. Am J Psychiatry 122:1132-1138, 1966.

7. Kaufman I, Peck A, Tagiori L: The family constellation and overt incestuous relations between father and daughter. Am J Orthopsy-

chiatry 24:266-279, 1954. 8. Bender L, Blau A: The

reaction of children

Orthopsychiatry 7:500-518, 1937. 9. Weiss T, Rogers E, Darwin M, et al: A study of girl sex victims. Psychiatr Q 29:1-27, 1955. 10. Krieger MT, Rosenfeld AA, Gordon A, et al: The therapy of children with an incest history. Am J Psychother, to be published. 11. Rosenfeld AA, Nadelson CC, Krieger MJ, to sexual relations with adults. Am J

et al: Incest and the sexual abuse of children. J Am Acad Child Psychiatry 16:327-339, 1977. 12. Flugel J: The Psychoanalytic Study of the Family. London, Hogarth Press, 1926. 13. Malmquist C: Report on females with three or more illegitimate pregnancies. Am J Orthopsychiatry 36:476-484, 1966. 14. Benward J, Denser Gerber JA: Incest as a causative factor in antisocial behavior: An exploratory study. Read before the American Academy of Forensic Sciences, February 1975. 15. Rasmussen A: The importance of sexual attacks on children less than 14 years of age for the development of mental disease and character anomalies. Acta Psychiatr Neurol 9:351-434, 1934. 16. Bender L, Grugett A: A follow-up report on children who had atypical sexual experience. Am J Orthopsychiatry 22:825-837, 1952. 17. Rosenfeld AA: Incest among female psychiatric patients. Am J Psychiatry, to be

published.

18. Weitzel WD, Powell BJ, Penick EC: Clinical management of father-daughter incest: A critical reexamination. Am J Dis Child 132:127\x=req-\ 130, 1978. 19. Croth J: Child sexual abuse demonstration and training program. Santa Clara County (Calif) Juvenile Probation Dept Quart Rep Jan 1-March 31, 1978. 20. Rosenfeld AA, Newberger EH: Compassion vs control. JAMA 237:2086-2088, 1977.

Endogamic incest and the victim-perpetrator model.

Endogamic Incest and the Victim-perpetrator Model Alvin A Rosenfeld, MD \s=b\ Traditionally incest has been seen as aggressive act of a deranged adul...
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