INCEST SYNDROMES: OBSERVATIONS IN A GENERAL HOSPITAL PSYCHIATRIC UNIT*
G. MOLNAR, M.D.! P, CAMERON, M.D.2
Introduction Incest, which is widely recorded in history and accepted as a universal fantasy in psychoanalysis (3), is not often encountered in general clinical settings. A recent review of the literature (5) confirms that most writings on this subject continue to show psychodynamic and forensic leanings. The condition is more frequent than is generally recognized (2) but is seldom reported because of the social stigma and lack of awareness of the possibilities of successful treatment. The unitary features in a series of 18 cases managed in a general hospital department of psychiatry'[ were impressive. Comment on these observations may be useful because there are few guidelines for the management of families where incest presents as an acute clinical problem, especially in situations without legal pressures. This paper describes the management of ten families whose initial psychiatric contact was the result of incestuous behaviour between the father and one or more of his daughters; the daughter who had precipitated disclosure was the identified patient. Another group of eight adult women whose • Based on a paper presented at the Canadian Psychiatric Association Meeting, June, 1973, Vancouver, B.C. 1 Assistant Professor, Department of Psychiatry, McMaster University, Hamilton, Ontario; In-patient Service, Department of Psychiatry, St. Joseph's Hospital, Hamilton, Ontario. 2 Assistant Professor, Department of Psychiatry, University of Toronto; In-patient Unit, Department of Psychiatry, Sunnybrook Hospital, Toronto, Ontario. t McMaster PSYChiatric Unit, St. Joseph's Hospital, Hamilton, Ontario.
Can. Psychiatr. Assoc. J. Vol. 20 (1975)
psychiatric presentation was related to incest (but long delayed) is briefly discussed. Incest is defined as "The crime of sexual intercourse, cohabitation or marriage between persons within the degrees of consanguinity or affinity wherein marriage is legally forbidden" (10). More pertinent to this discussion is the concept of incest behaviour (11), which has no juridic configuration and extends to a wider range of comportments which mayor may not include intercourse. Observations and Data On reviewing the ten families, it became evident that the build-up of the crisis and the course of events after disclosure showed similarities which were suggestive of a pattern. The clinical features had sufficient consistency to delineate a syndrome composed of depressive-suicidal or runaway reactions associated with disclosure of incest in mid-adolescent girls. In the adult delayed-presentation group, the syndrome consisted of sexual problems stemming from previous untreated incest in otherwise varying clinical pictures. In the first group, contact with psychiatry occurred when the daughters were midadolescent (mean age = 15, range 14-17 years). In most cases the incestuous behaviour had persisted for years prior to disclosure (mean duration = 4.5 years, range 1 month - 12 years). Although the reactions leading to disclosure and referral had various precipitants the common under-
373
374
CANADIAN PSYCHIATRIC ASSOCIATION JOURNAL
lying factor was that the girls had achieved sufficient social and sexual awareness to permit the drastic step of exposing the family; they became sensitive to social pressures and contrasted the family mores with the moral code prevailing in the community. Furthermore, after puberty their own sexual interests led them beyond the confines of the family. In several cases the precipitating event was connected with jealous feelings of the girl toward the mother who, in one case, was about to remarry and in another had taken a new lover. Examination of the circumstances of disclosure and the tortuous route to psychiatric referral yielded some of the most interesting findings. One case typifies the indirectness of referral - a daughter acknowledged, during a social gathering in which the subject of incest came up, that her father had been sexually involved with her for years. The mother, who in fact had been aware of the situation, could now no longer delay action and spoke to her minister who contacted a social agency who then called the police. The police laid charges against the father who hired a lawyer and he contacted the family physician, who finally requested a psychiatric consultation. In four of the five families where the identified patient had older sisters, there was positive information that they too had been involved in incestuous behaviour. This raises the interesting question of the difference in personality between the older sisters and the younger one who precipitated the disclosure, and who, in many cases, seemed to be the most intact member of her family. On the other hand in six out of eight families there was no involvement of the younger sisters. Of the two remaining families, in one, involvement occurred before disclosure and in the other no definite information was available. Therefore it is likely that disclosure protects the younger daughters from sexual approaches by the father. In the families with multiple incest, the pattern consisted of sequential involvement of the daughters, beginning with the oldest. In the second group, adults with delayed
Vol. 20, No.5
presentation (ages ranging from 18-37 years) contact with psychiatry occurred from six months to ten years after termination of the incestuous behaviour. This group merits further investigation for the study of the long-term effects of untreated incest (9). Treatment of the Adolescent Girl In hospital, the principal approach was use of the therapeutic milieu of the ward as an environment where the girls could recover from the disorganizing effects of the crisis. Within the context of team management, individual psychotherapy, with a nurse as primary therapist was used in each case to help recovery, plan adaptively for the future and deal with the emotional conflicts associated with incest and its disclosure. The nurse therapists were also role models for the girls who, coming from a situation of family pathology and social stigma, benefitted from a relationship with a socially integrated person with whom they could identify. In several cases, the incest behaviour was not immediately disclosed but was elicited during subsequent interviews by a more experienced clinician or by a nurse who had gained a patient's confidence. In these instances, treatment was at an impasse until disclosure made it possible to deal with the problem. None of the girls required major psychotropic medication or electro-convulsive therapy nor was any gross psychopathology durably present. Therapy was also helpful in the critical period during which the patient reestablished herself in the community. This phase was marked by the working out of a new relationship with her family which, in almost every case, was characterized by separation necessitated by the disclosure. The survival of the family unit and the well-being of the daughter seemed to depend upon her extrusion or departure. In nine out of ten cases the disposition was outside the original home - the older girls were usually referred to group homes, the younger ones to foster homes. In only one case was the extended family (an aunt) helpful in sheltering the adolescent. In several cases Children's Aid Societies in-
August, 1975
INCEST SYNDROMES
itiated proceedings to make the girls wards of the Crown.
375
probation applied, therapy proceeded for several months in the face of great resistance. The authors agree with Kennedy and Family Aspects Cormier (7) that ventilation of the problem By the criteria of Hollingshead and Red- with the entire family should be useful lich (6) the families were concentrated in because it makes recurrence unlikely. social class IV. After disclosure, half the Nevertheless, with such unwilling patients families maintained a considerable degree the value of ongoing formal family therapy of stability in spite of dysfunctional marital is questionable and it is doubtful whether relationships, but the others were already the use of probation or other forms of disorganized multi-problem families. The coercion to compel the family to attend adolescent girls were not promiscuous and formal psychiatric treatment is helpful. only one had a problem of alcohol or drugs. Rather than psychotherapy along classic They displayed a certain degree of assent in models, it is preferable to provide the girl the incest behaviour until the time of disclo- and her family with long-term support and sure. Aside from this behaviour the fathers observation by social agency workers or were non-criminal, and in Weinberg's probation officers and with psychiatric typology, they fall into the category of back-up when required. endogamic incest, which refers to an adult who confines his sexual objects to family Legal Aspects Legal involvement showed the same unmembers (11). There were no examples of Weinberg's other two types - fathers planned, almost accidental nature of the whose incestuous behaviour is part of either initial psychiatric involvement. The prean indiscriminate promiscuity or of a sence or absence of Court involvement as pedophilia. Striking traits were the rigid well as the punishments meted out seemed personalities and the lack of empathy of the to depend on chance factors surrounding the parents. In five cases, the behaviour was circumstances of disclosure rather than on associated with alcoholism of both parents any systematic correlation with the severity or of just the father, and some physical of the incest behaviour in terms of social abuse of the daughter occurred separately or and psychological damage and family with incest behaviour. One of the fathers breakdown. Cases are treated differently rationalized his behaviour as a punishment according to whether they are referred to a of his daughter's association with "hip- Juvenile and Family Court where the hearpies" and another by stating that "it was ings are private, the purpose therapeutic better she learn sex from him than from the and all members of the family are involved, street". Invariably, the marital and sexual or to a Criminal Court which is correctional relationship of the parents was dysfunc- and rehabilitative rather than therapeutic. tional (8). In some cases the wife resisted The Crown Attorney is the key person in intercourse because she feared pregnancy, deciding in which Court unclear cases are in others she had become unattractive be- heard. Because positive evidence of incest cause of obesity or personal neglect. It was is very difficult to obtain (4), the charge is clear that incest behaviour could not have frequently reduced from "incest" to "conpersisted for so many years in any of the tributing to juvenile delinquency" or "sexfamilies without the mother's tolerance. In ual assault". The authors agree with Corno instance did the initiative of disclosure mier et at. (l) that most cases can be come spontaneously from the mother, who managed without a prison sentence because acted only when the daughter's attitude probation or other pressures, short of incarceration, are often sufficient to ensure an made exposure inevitable. While usually possible during the crisis adequate duration of support and observaphase, family involvement proved difficult tion. If the narrow legal definition is used or impossibe to maintain over a longer and the procedure is limited to the selection term. In one case, where the constraint of and punishment of one offender, significant
376
CANADIAN PSYCHIATRIC ASSOCIATION JOURNAL
aspects of a complex problem involving the entire family will be overlooked.
Conclusions The pattern emerging from these cases suggests the existence of an ince~t syndrome which is more frequent than IS generally recognized, especially when referred to the population at risk - girls in midadolescence. Incest. syndromes accounted for 5 percent of admissions of girls aged 14-17 to our Inpatient Service in 1969-72. The acute clinical pictures identified are the depressive-suicidal reaction and the runaway reaction. Not included in those n~m bers are five cases in which it was possible to conduct evaluation and treatment without recourse to hospitalization. It is evident that a much greater number of potential cases remain unreported and untreated. . The treatment of the adolescent patient proved beneficial in the short-term. and in several cases from the vantage point of a two-year follow-up. The criteria for improvement were: success in resolving. the conflict over disclosure and separation; adapting to a new environment; establishing peer relationships and improved performance at school. Formal long-term psychotherapy did not prove to be workable - either the patient dropped out or the therapist realized that he could do no more for her. The most successful approach proved to be separation from the family, short-term individual psychotherapy by a psychiatric nurse, and transition to longterm supportive contact with a social agency worker or probation officer. Reestablishment of the family unit has been proposed as the goal of treatment, and family therapy the appropriate modality (7). Experience proved this to be unfeasible because of the great resistance and the intensity of the daughter's negative feelings against her parents, but it was ~lmost .always possible to involve the family dunng the crisis phase, and these sessions had therapeutic as well as diagnostic value. Intervention during crisis is effective because the family defences are in disarray and the ventilation has great impact. In spite of the stress of disclosure, families
Vol. 20, No.5
which were previously stable although dysfunctional showed a great ability to compensate. This stress necessarily produced changes in family relationships and behaviour, rendering impossible a return to the previous situation. For this reason, recurrence of incest after disclosure is very unlikely. It was noted that there is no clear awareness of the incest syndromes among mental health professionals or the public, with the result that no group of caretakers has a broad view of the problem or a definite mandate to deal with it. This, as much as the resistance of the involved families, is responsible for delays or failures to report or refer cases. To correct the situation, a co-ordinated approach by the social agencies, the law and psychiatry is required. Although psychiatrists have not developed consistent methods of intervention, it is suggested that effective approaches can be developed. Furthermore, there is a tendency to give little weight to the common psychiatric symptomatology with which the patients present and to the br?ad app!oach which the management requires. WIthout broader perspective, the psychopathology of incest syndromes may be highlighted, and negative feelings among therapists with regard to their ability to be useful will be enhanced. A wider awareness of the incest syndromes is necessary for increased casefinding and the availability of effective treatment for affected families. Timely intervention helps the adolescent girl and her family, protects the younger sisters and probably reduces future psychiatric .morbidity by minimizing the psychological and social damage. References I. Cormier, B. M., et al. Psychodynamics of father-daughter incest. Can. Psychiatr. Assoc. J. 7: 203-217,1962. 2. Doehler, R.: Incest - the secret crime against children. Chatelaine 42: 20, March, 1969. 3. Freud, S.: Totem and Taboo. New York, W. W. Norton & Co. Inc., 1950. 4. Greenland, C.: Research and methodology - incest. Br. J. Delinquency 9: I, 62-65, 1958.
August, 1975
INCEST SYNDROMES
5. Henderson, D. J.: Incest: A synthesis of data. Can. Psychiatr. Assoc. J. 17: 299313,1972. 6. Hollingshead, A. and Redlich, F. C.: Social Class and Mental Illness, A Community Study. New York, Wylie, 1958. 7. Kennedy, M. and Cormier, B. M.: Fatherdaughter incest: treatment of a family. Interdisciplinary problems in criminology. Papers of the American Society of Criminology, Columbus Ohio State University 143-149,1963. 8. Lustig, N., et. al.: Incest: a family group survival pattern. Arch. Gen. Psychiatry 14: 31-40,1966. 9. Sloane, P. S. and Karpinski, E.: Effects of incest upon participants. Am. J. Orthopsychiatry 12: 666-673, 1942. 10. The Random House Dictionary of the English Language, (Unabridged Edition), New York, Random House, 1973. 11. Weinberg, S. K.: Incest Behaviour. New York, Citadel Press, 1955.
Resume Cette etude presente, sur les syndromes d'inceste, des observations faites en hopital psychiatrique general au cours d'une periode de trois annees, Ces syndromes, consequences d'incestes pere-fille , n'ont guere retenu l'attention des psychiatres, ceux-ci s'attachant d'abord aux questions psychodynamiques et legales. Or, les syn-
377
dromes d'inceste sont plus frequents qu'on veut bien l'admettre, mais on en fait peu etat, etant donne l'opprobre sociale et une certaine ignorance des traitements efficaces. Les cas cites ici sont ceux de dix familles au sein desquelles une crise a suivi la divulgation de l'inceste. Dans la description qu'on en donne, on insiste sur Ie traitement de l'adolescente, les aspects familiaux et les aleas des demarches legales. On parle aussi d'un groupe de femmes adultes qui ont presente des effets tardifs d'incestes non traites, Le traitement des familles, indique-t-on, exige largeur de vues et diversite de moyens, et fait appel aux professionnels des agences psychiatriques, juridiques et sociales. Si I'on sait s'y prendre, de bons resultats sont possibles car, malgre des relations fonctionnellement perturbees, les adolescentes et leurs familles font souvent preuve de capacites d' adaptation et de restitution. Toutefois, les professionnels de la sante mentale et Ie public doivent mieux connaitre ces syndromes si I' on veut que les cas soient davantage signales et le traitement plus approprie; ainsi, les consequences psychologiquement et socialement nefastes de ces comportements et de leurs syndromes pourront etre reduites.
Temptation is the fire that brings up the scum ofthe heart.
Thomas Boston (Scottish Divine) 1676-1732
G. MOLNAR, M.D.! P, CAMERON, M.D.2
Introduction Incest, which is widely recorded in history and accepted as a universal fantasy in psychoanalysis (3), is not often encountered in general clinical settings. A recent review of the literature (5) confirms that most writings on this subject continue to show psychodynamic and forensic leanings. The condition is more frequent than is generally recognized (2) but is seldom reported because of the social stigma and lack of awareness of the possibilities of successful treatment. The unitary features in a series of 18 cases managed in a general hospital department of psychiatry'[ were impressive. Comment on these observations may be useful because there are few guidelines for the management of families where incest presents as an acute clinical problem, especially in situations without legal pressures. This paper describes the management of ten families whose initial psychiatric contact was the result of incestuous behaviour between the father and one or more of his daughters; the daughter who had precipitated disclosure was the identified patient. Another group of eight adult women whose • Based on a paper presented at the Canadian Psychiatric Association Meeting, June, 1973, Vancouver, B.C. 1 Assistant Professor, Department of Psychiatry, McMaster University, Hamilton, Ontario; In-patient Service, Department of Psychiatry, St. Joseph's Hospital, Hamilton, Ontario. 2 Assistant Professor, Department of Psychiatry, University of Toronto; In-patient Unit, Department of Psychiatry, Sunnybrook Hospital, Toronto, Ontario. t McMaster PSYChiatric Unit, St. Joseph's Hospital, Hamilton, Ontario.
Can. Psychiatr. Assoc. J. Vol. 20 (1975)
psychiatric presentation was related to incest (but long delayed) is briefly discussed. Incest is defined as "The crime of sexual intercourse, cohabitation or marriage between persons within the degrees of consanguinity or affinity wherein marriage is legally forbidden" (10). More pertinent to this discussion is the concept of incest behaviour (11), which has no juridic configuration and extends to a wider range of comportments which mayor may not include intercourse. Observations and Data On reviewing the ten families, it became evident that the build-up of the crisis and the course of events after disclosure showed similarities which were suggestive of a pattern. The clinical features had sufficient consistency to delineate a syndrome composed of depressive-suicidal or runaway reactions associated with disclosure of incest in mid-adolescent girls. In the adult delayed-presentation group, the syndrome consisted of sexual problems stemming from previous untreated incest in otherwise varying clinical pictures. In the first group, contact with psychiatry occurred when the daughters were midadolescent (mean age = 15, range 14-17 years). In most cases the incestuous behaviour had persisted for years prior to disclosure (mean duration = 4.5 years, range 1 month - 12 years). Although the reactions leading to disclosure and referral had various precipitants the common under-
373
374
CANADIAN PSYCHIATRIC ASSOCIATION JOURNAL
lying factor was that the girls had achieved sufficient social and sexual awareness to permit the drastic step of exposing the family; they became sensitive to social pressures and contrasted the family mores with the moral code prevailing in the community. Furthermore, after puberty their own sexual interests led them beyond the confines of the family. In several cases the precipitating event was connected with jealous feelings of the girl toward the mother who, in one case, was about to remarry and in another had taken a new lover. Examination of the circumstances of disclosure and the tortuous route to psychiatric referral yielded some of the most interesting findings. One case typifies the indirectness of referral - a daughter acknowledged, during a social gathering in which the subject of incest came up, that her father had been sexually involved with her for years. The mother, who in fact had been aware of the situation, could now no longer delay action and spoke to her minister who contacted a social agency who then called the police. The police laid charges against the father who hired a lawyer and he contacted the family physician, who finally requested a psychiatric consultation. In four of the five families where the identified patient had older sisters, there was positive information that they too had been involved in incestuous behaviour. This raises the interesting question of the difference in personality between the older sisters and the younger one who precipitated the disclosure, and who, in many cases, seemed to be the most intact member of her family. On the other hand in six out of eight families there was no involvement of the younger sisters. Of the two remaining families, in one, involvement occurred before disclosure and in the other no definite information was available. Therefore it is likely that disclosure protects the younger daughters from sexual approaches by the father. In the families with multiple incest, the pattern consisted of sequential involvement of the daughters, beginning with the oldest. In the second group, adults with delayed
Vol. 20, No.5
presentation (ages ranging from 18-37 years) contact with psychiatry occurred from six months to ten years after termination of the incestuous behaviour. This group merits further investigation for the study of the long-term effects of untreated incest (9). Treatment of the Adolescent Girl In hospital, the principal approach was use of the therapeutic milieu of the ward as an environment where the girls could recover from the disorganizing effects of the crisis. Within the context of team management, individual psychotherapy, with a nurse as primary therapist was used in each case to help recovery, plan adaptively for the future and deal with the emotional conflicts associated with incest and its disclosure. The nurse therapists were also role models for the girls who, coming from a situation of family pathology and social stigma, benefitted from a relationship with a socially integrated person with whom they could identify. In several cases, the incest behaviour was not immediately disclosed but was elicited during subsequent interviews by a more experienced clinician or by a nurse who had gained a patient's confidence. In these instances, treatment was at an impasse until disclosure made it possible to deal with the problem. None of the girls required major psychotropic medication or electro-convulsive therapy nor was any gross psychopathology durably present. Therapy was also helpful in the critical period during which the patient reestablished herself in the community. This phase was marked by the working out of a new relationship with her family which, in almost every case, was characterized by separation necessitated by the disclosure. The survival of the family unit and the well-being of the daughter seemed to depend upon her extrusion or departure. In nine out of ten cases the disposition was outside the original home - the older girls were usually referred to group homes, the younger ones to foster homes. In only one case was the extended family (an aunt) helpful in sheltering the adolescent. In several cases Children's Aid Societies in-
August, 1975
INCEST SYNDROMES
itiated proceedings to make the girls wards of the Crown.
375
probation applied, therapy proceeded for several months in the face of great resistance. The authors agree with Kennedy and Family Aspects Cormier (7) that ventilation of the problem By the criteria of Hollingshead and Red- with the entire family should be useful lich (6) the families were concentrated in because it makes recurrence unlikely. social class IV. After disclosure, half the Nevertheless, with such unwilling patients families maintained a considerable degree the value of ongoing formal family therapy of stability in spite of dysfunctional marital is questionable and it is doubtful whether relationships, but the others were already the use of probation or other forms of disorganized multi-problem families. The coercion to compel the family to attend adolescent girls were not promiscuous and formal psychiatric treatment is helpful. only one had a problem of alcohol or drugs. Rather than psychotherapy along classic They displayed a certain degree of assent in models, it is preferable to provide the girl the incest behaviour until the time of disclo- and her family with long-term support and sure. Aside from this behaviour the fathers observation by social agency workers or were non-criminal, and in Weinberg's probation officers and with psychiatric typology, they fall into the category of back-up when required. endogamic incest, which refers to an adult who confines his sexual objects to family Legal Aspects Legal involvement showed the same unmembers (11). There were no examples of Weinberg's other two types - fathers planned, almost accidental nature of the whose incestuous behaviour is part of either initial psychiatric involvement. The prean indiscriminate promiscuity or of a sence or absence of Court involvement as pedophilia. Striking traits were the rigid well as the punishments meted out seemed personalities and the lack of empathy of the to depend on chance factors surrounding the parents. In five cases, the behaviour was circumstances of disclosure rather than on associated with alcoholism of both parents any systematic correlation with the severity or of just the father, and some physical of the incest behaviour in terms of social abuse of the daughter occurred separately or and psychological damage and family with incest behaviour. One of the fathers breakdown. Cases are treated differently rationalized his behaviour as a punishment according to whether they are referred to a of his daughter's association with "hip- Juvenile and Family Court where the hearpies" and another by stating that "it was ings are private, the purpose therapeutic better she learn sex from him than from the and all members of the family are involved, street". Invariably, the marital and sexual or to a Criminal Court which is correctional relationship of the parents was dysfunc- and rehabilitative rather than therapeutic. tional (8). In some cases the wife resisted The Crown Attorney is the key person in intercourse because she feared pregnancy, deciding in which Court unclear cases are in others she had become unattractive be- heard. Because positive evidence of incest cause of obesity or personal neglect. It was is very difficult to obtain (4), the charge is clear that incest behaviour could not have frequently reduced from "incest" to "conpersisted for so many years in any of the tributing to juvenile delinquency" or "sexfamilies without the mother's tolerance. In ual assault". The authors agree with Corno instance did the initiative of disclosure mier et at. (l) that most cases can be come spontaneously from the mother, who managed without a prison sentence because acted only when the daughter's attitude probation or other pressures, short of incarceration, are often sufficient to ensure an made exposure inevitable. While usually possible during the crisis adequate duration of support and observaphase, family involvement proved difficult tion. If the narrow legal definition is used or impossibe to maintain over a longer and the procedure is limited to the selection term. In one case, where the constraint of and punishment of one offender, significant
376
CANADIAN PSYCHIATRIC ASSOCIATION JOURNAL
aspects of a complex problem involving the entire family will be overlooked.
Conclusions The pattern emerging from these cases suggests the existence of an ince~t syndrome which is more frequent than IS generally recognized, especially when referred to the population at risk - girls in midadolescence. Incest. syndromes accounted for 5 percent of admissions of girls aged 14-17 to our Inpatient Service in 1969-72. The acute clinical pictures identified are the depressive-suicidal reaction and the runaway reaction. Not included in those n~m bers are five cases in which it was possible to conduct evaluation and treatment without recourse to hospitalization. It is evident that a much greater number of potential cases remain unreported and untreated. . The treatment of the adolescent patient proved beneficial in the short-term. and in several cases from the vantage point of a two-year follow-up. The criteria for improvement were: success in resolving. the conflict over disclosure and separation; adapting to a new environment; establishing peer relationships and improved performance at school. Formal long-term psychotherapy did not prove to be workable - either the patient dropped out or the therapist realized that he could do no more for her. The most successful approach proved to be separation from the family, short-term individual psychotherapy by a psychiatric nurse, and transition to longterm supportive contact with a social agency worker or probation officer. Reestablishment of the family unit has been proposed as the goal of treatment, and family therapy the appropriate modality (7). Experience proved this to be unfeasible because of the great resistance and the intensity of the daughter's negative feelings against her parents, but it was ~lmost .always possible to involve the family dunng the crisis phase, and these sessions had therapeutic as well as diagnostic value. Intervention during crisis is effective because the family defences are in disarray and the ventilation has great impact. In spite of the stress of disclosure, families
Vol. 20, No.5
which were previously stable although dysfunctional showed a great ability to compensate. This stress necessarily produced changes in family relationships and behaviour, rendering impossible a return to the previous situation. For this reason, recurrence of incest after disclosure is very unlikely. It was noted that there is no clear awareness of the incest syndromes among mental health professionals or the public, with the result that no group of caretakers has a broad view of the problem or a definite mandate to deal with it. This, as much as the resistance of the involved families, is responsible for delays or failures to report or refer cases. To correct the situation, a co-ordinated approach by the social agencies, the law and psychiatry is required. Although psychiatrists have not developed consistent methods of intervention, it is suggested that effective approaches can be developed. Furthermore, there is a tendency to give little weight to the common psychiatric symptomatology with which the patients present and to the br?ad app!oach which the management requires. WIthout broader perspective, the psychopathology of incest syndromes may be highlighted, and negative feelings among therapists with regard to their ability to be useful will be enhanced. A wider awareness of the incest syndromes is necessary for increased casefinding and the availability of effective treatment for affected families. Timely intervention helps the adolescent girl and her family, protects the younger sisters and probably reduces future psychiatric .morbidity by minimizing the psychological and social damage. References I. Cormier, B. M., et al. Psychodynamics of father-daughter incest. Can. Psychiatr. Assoc. J. 7: 203-217,1962. 2. Doehler, R.: Incest - the secret crime against children. Chatelaine 42: 20, March, 1969. 3. Freud, S.: Totem and Taboo. New York, W. W. Norton & Co. Inc., 1950. 4. Greenland, C.: Research and methodology - incest. Br. J. Delinquency 9: I, 62-65, 1958.
August, 1975
INCEST SYNDROMES
5. Henderson, D. J.: Incest: A synthesis of data. Can. Psychiatr. Assoc. J. 17: 299313,1972. 6. Hollingshead, A. and Redlich, F. C.: Social Class and Mental Illness, A Community Study. New York, Wylie, 1958. 7. Kennedy, M. and Cormier, B. M.: Fatherdaughter incest: treatment of a family. Interdisciplinary problems in criminology. Papers of the American Society of Criminology, Columbus Ohio State University 143-149,1963. 8. Lustig, N., et. al.: Incest: a family group survival pattern. Arch. Gen. Psychiatry 14: 31-40,1966. 9. Sloane, P. S. and Karpinski, E.: Effects of incest upon participants. Am. J. Orthopsychiatry 12: 666-673, 1942. 10. The Random House Dictionary of the English Language, (Unabridged Edition), New York, Random House, 1973. 11. Weinberg, S. K.: Incest Behaviour. New York, Citadel Press, 1955.
Resume Cette etude presente, sur les syndromes d'inceste, des observations faites en hopital psychiatrique general au cours d'une periode de trois annees, Ces syndromes, consequences d'incestes pere-fille , n'ont guere retenu l'attention des psychiatres, ceux-ci s'attachant d'abord aux questions psychodynamiques et legales. Or, les syn-
377
dromes d'inceste sont plus frequents qu'on veut bien l'admettre, mais on en fait peu etat, etant donne l'opprobre sociale et une certaine ignorance des traitements efficaces. Les cas cites ici sont ceux de dix familles au sein desquelles une crise a suivi la divulgation de l'inceste. Dans la description qu'on en donne, on insiste sur Ie traitement de l'adolescente, les aspects familiaux et les aleas des demarches legales. On parle aussi d'un groupe de femmes adultes qui ont presente des effets tardifs d'incestes non traites, Le traitement des familles, indique-t-on, exige largeur de vues et diversite de moyens, et fait appel aux professionnels des agences psychiatriques, juridiques et sociales. Si I'on sait s'y prendre, de bons resultats sont possibles car, malgre des relations fonctionnellement perturbees, les adolescentes et leurs familles font souvent preuve de capacites d' adaptation et de restitution. Toutefois, les professionnels de la sante mentale et Ie public doivent mieux connaitre ces syndromes si I' on veut que les cas soient davantage signales et le traitement plus approprie; ainsi, les consequences psychologiquement et socialement nefastes de ces comportements et de leurs syndromes pourront etre reduites.
Temptation is the fire that brings up the scum ofthe heart.
Thomas Boston (Scottish Divine) 1676-1732
