Yousuf Raza – Child Sexual Abuse
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AI: Transcript ©
Yes, yes, yes, I announced last week.
We have a very special guest today.
Um Dr. Aisha Minhas, she uh was my
teacher at the Institute of Psychiatry.
Not only that, Dr. Aisha as head of
the child psychiatry unit initiated this idea of
a campaign called Ankehi.
Uh Ankehi was a campaign looking to raise
awareness with respect to child sexual abuse.
Uh what needs to be done.
So, there was a whole campaign that we
did.
I was fortunate to be a part of
that campaign with Dr. Aisha Minhas um and
um we have been honored by her presence
today.
So, without further ado, I would request Dr.
Aisha to join us.
Assalamu alaikum ma'am.
Assalamu alaikum.
Assalamu alaikum.
Assalamu alaikum.
Assalamu alaikum.
Ma'am, thank you so much for um
joining us on Psych Baitak.
Uh we're honored to have you.
Um I think everyone wants to know where
where he came from and how it was
uh why why was it so important that
the entire campaign was launched?
Thank you so much for for inviting me.
So, so I think it was around uh
2013 perhaps.
and then uh uh
uh we all got together.
uh I think uh um
you know, I can trace it back to
my So, you
know, not quite right.
uh you know, there were times when I
felt that some adults would not be uh
handling the children in a nice manner and
there was something wrong about it and obviously,
I was a young child and we, you
know, we would talk about it and then
forget about it.
So, but this thing remained and as very
young children, I could sense this feeling of
unease and something wrong about this.
Anyhow,
uh So,
I realized uh which
I could because I was very sensitive about
this.
So, I would always ask about their childhood
and I would, you know, connect things like
anxiety, depression, personality difficulties, especially borderline traits,
self-harm, suicidal attempts.
You know, many of those patients would describe
a difficult or a traumatic childhood and then
when I started child psychiatry, this thing was
augmented.
So, I could see that these children were
coming from very disorganized and disorderly households and
so then, you know, it struck me that
50-70% of adult mental health issues
arise in childhood and if there is such
a strong connection with causality that if there
is trauma, then you are vulnerable to develop
mental health issues in child adolescence and extending
on to your adult life.
So, then, you know, it made a lot
of sense.
So, why not, you know, work at the
prevention level?
So, I thought that trauma in children is
a big public health issue and we need
to prevent this.
It will be so cost-effective also.
So, I think that's where I made the
connection and I had this passion.
Then, I think as psychiatrists, if we don't
do this, then who will do it?
So, we formed this group.
As you know, you were a very important
member of that group and we made a
movie and we did workshops and then I
started presenting it on different forums and unfortunately,
I realized that nobody was talking about this
even amongst the mental health professionals and sometimes,
I would get, you know, shake of the
head or some kind of disgust from people
when I would present this.
So, I think that fueled the fire more,
you know, when I joined psychiatry.
Mental health professionals will be cordial to discuss
this.
Because this is something very important.
So, I think that's it.
But obviously, I don't have a big team
as we used to have in the institute
when I was working.
Yusuf, you are muted.
I'm sorry.
I'm back.
So, even whatever we were able to do,
as you said, it's shocking that psychiatrists and
the community of psychiatrists in Pakistan didn't take
ownership of it.
So, whatever we did, whatever we were able
to do under the Ankahi banner, it's still
unparalleled.
We will not find psychiatrists to have participated.
Apart from psychiatrists, we find some organisations and
celebrities in the community who are talking about
it.
But shockingly, psychiatrists themselves don't seem to be
giving the level of importance that this topic
deserves.
That's right.
So, very few, you know, we know that
Rozan is doing a lot of work.
So, very few people are in this and
I think we need more and more strength
to take it forward.
Ma'am, even if psychiatrists are not paying
heed to this important topic, so how is
the general public's attitude?
What is their attitude to this topic?
Because you have done a lot of fieldwork
too.
So, especially the parents of the victims of
child sexual abuse, their families, what did you
see there?
What was their response towards this?
When we used to do workshops, I think
they were very successful.
We did with the RMC students or universities
or colleges.
So, they were taken very well and we
had tremendous attendance, which just told me that
this touches their heart.
And looking at how common it is, you
know, it's anybody's guess that many of us
or many of the people who were attending
were relating to it so well because they
might have, you know, had such experiences.
But generally, if you look at the public,
then obviously there is so much stigma around
this.
And it's such a shame, anything to do
with *, even if it's, you know, good
* or whatever, that our societal norms and
some religious norms should also be backed.
So, it's a very fine thread that we
don't cross.
So, acceptance is very low, unfortunately.
And that's why I think awareness raising is
so important because when a child disclosures and
if he doesn't get parental support, then that's
like a double trauma.
Many times in my patients, I have seen
this, that they are further traumatized.
So, acceptance in the general public to accept
it or to how to deal with it
is very, very low and not right.
And ma'am, can you define for the
audience, when you use the word sexual abuse,
what does it mean?
Because a lot of the time people think
we are only talking about the *.
So, what will come in sexual abuse?
Yes.
So, child sexual abuse means that a big
person, a big child uses a small child
for his sexual gratification.
And it can also include touching activities, for
example, fondling or *.
But non-touch activities like showing * or
exposing yourself.
Or even in its definition, it also comes
that looking at a child in a wrong
way is also child sexual abuse.
So, it covers a very broad spectrum.
And ma'am, in terms of the impact,
as you said, abuse is understood to be
to the extent of * or *.
And then it is also understood that the
rest of the forms do not make any
difference.
What is it?
It is a child.
He will forget.
How will he know?
Stuff like that.
So, what do we see with respect to
our clinical experience as well as what empirical
evidence has to show us?
That the other forms that you have described,
how much of an impact do they have
on the mental health of the growing child?
So, I think you are very right.
And the cases that come before us are
those where there is a lot of violence,
* or murder.
So, that's why I have always been more
interested in looking at and talking more about
the abuse that goes on in our homes,
in our schools and in the community.
Which is going on silently.
There is no need for force.
There is no need for force in child
abuse.
Because the adult is anyway so much more
powerful and has so much of power over
the child that there is no need for
force.
The child is easily given.
So, all kinds of abuse, I would say,
have a tremendous impact on the child.
So, when child is abused, there can be
a lot of psychological effects.
For example, the first and foremost would be
this feeling of helplessness and powerlessness that he
can't do anything.
Sadness will arise.
Anxiety will arise.
Guilt is a very important part of abuse.
There is a lot of feeling of shame
in this.
And apart from these psychological effects, as you
know, the defense mechanisms that we use, they
start to be used in such a way
that define the child's pattern to stress.
For example, dissociation is very common.
The child dissociates himself from those painful feelings
to deal with this trauma.
And then that becomes his reaction pattern to
stress in later life.
And it may go on to dissociative disorders.
The child uses denial.
Minimizes this thing.
I remember a little girl, about 11 years
old, who was being abused by her father.
And she was a very intelligent little thing.
And you know how she was rationalizing the
abuse.
She said, You know, she had
rationalized it in a way.
All fathers have to do it.
Children will go to such an extent to
kind of, because it's a conflict between love
and hate.
You love your father.
He's your savior.
But the savior has now turned to becoming
the perpetrator and you hate him.
So you're caught in this tug of war.
There is love and there is hatred.
So, I think, And then, you know, what
is most important is that the effects do
not end, even when the abuse does.
So the effects are so long lasting.
And believe me, you will be carrying this
burden to your grave.
Obviously, you cannot get rid of those memories.
So they are going to stay with you.
And when we look at anxiety, depression, and
cutting in adults, in borderline personality, over 60
% of patients describe having gone through child
sexual abuse.
There are also a lot of suicidal attempts
in these children who have gone through this.
So I think there are so many effects,
both short term and long term.
And there is no one pathognomonic symptom.
So that's the whole thing.
You know, you really have to be very
aware to diagnose and spot.
So, ma'am, you said there is no
one symptom.
But our parents have a big concern.
How do we know that our child is
going through such an abuse at school, college,
or wherever?
So what should parents pay attention to?
What should they be aware of?
If they see those signs, they should be
vigilant.
Yes, that's a very practical question.
So, the red flags, I think, if we
remember one thing, when you see your child's
behavior change, when you see a definite change
at some point in time, then something is
wrong somewhere.
A good child who used to be happy,
who used to talk, now he's quiet, he's
living in his room, his anger outbursts are
happening, then please suspect something.
And then there will be a slight difference
in age.
So younger children will show a regression in
their milestones.
So the child will cling to his mother
more.
Maybe a nocturnal aneurysm will start.
He had attained bladder control, but now it
leaks.
He becomes whiny, he becomes irritable.
Similarly, in older children, there can be externalizing
symptoms, like tantrums and anger outbursts.
Or he internalizes this distress and goes into
cutting or overdosing or depression or anxiety.
In both groups and in all children, one
more important symptom is over-sexualized behavior.
So younger children, can show
sexualized play in their play I'll tell you
again, this happened when I was young and
growing up and I suddenly went into a
room where some girls were playing and they
hid things and noise and you left, you
left.
And I saw that one of them was
drawing the male part.
And they were about not more than seven
to eight years old.
So definitely, definitely a seven-year-old is
not supposed to know the gross anatomy of
the male or female sexual organs.
So if you get this kind of play
at any age, which is beyond their developmental
level, then please suspect that they've been exposed
to this kind of thing somewhere.
And ma'am, are there any studies in
Pakistan how much this is common in general
population?
Or have you seen anything in your fieldwork?
Unfortunately, we have a synopsis of this.
And we thought that we would do it
in medical college students, how much they can
remember, but we have not been able to
do.
So the figures that we use are the
ones that are kind of global figures, one
in five girls and one in 20 boys.
But believe me, I think that's a big
underestimate because most of the cases are not
reported.
So I think those that are reported.
And the clinical practice in adult psychiatry, it's
a surprising number of people that we identify
when you trace their history back and they
do acknowledge the cases of depression that we
see, anxiety that we see, personality disorders that
we see, they would acknowledge that that number
is far greater than one in five in
the female audience that we're seeing.
And you said one in 20.
So there is also this common myth associated
that it's not in boys, that it's only
with girls.
But I think it's important to highlight that
it is a possibility, it is a threat,
and it has psychological consequences in boys as
well.
Definitely, definitely.
It happens in boys, though less frequent.
And boys tend to have a lesser percentage
of boys disclosing this.
So I think it's probably against their macho
image in society that boys are strong and
they're not supposed to talk like this.
So they disclose less.
But it definitely happens in boys.
And similarly, when these issues are highlighted it
is when a gang is caught or some
crime has taken place, the murder and all
of that has become, it's really vulgar to
the extent that it goes.
And that sort of reinforces another common conception
that it is usually these kinds of evil
criminal people out there on the streets, the
strangers that do it.
But statistics tell us otherwise.
I think that's a very important point.
Stranger danger is unreal.
Because only 7% are strangers.
93% of perpetrators are known to the
child.
Of which 64% are acquaintances, and 33
% are your relatives.
So we are always talking about the 7
% that if someone gives you sweets at
school, don't take it.
But that's only 7%.
So the greater danger lies within our homes
and our schools and people we know.
So, ma'am, typically, if we look at
it, any victim of sexual abuse in any
home, the first cry for help is to
approach their parents.
If it's a sibling or family member, the
parents or possibly the older siblings.
So if they approach them, should the parents
take it at face value or should they
suspect that he's making up some story?
He is, sorry?
That he's making up a story, or there
is some other motive.
I think that's hugely important.
Like we said, when there's disclosure, you get
a second trauma if the next person doesn't
believe you.
So first of all, think about how difficult
disclosure is.
It's such a shameful thing and it's so
traumatic.
And if a child is picking up the
courage to tell the parent or anybody he
trusts, then you must kind of praise the
child for his bravery.
And you have to believe him instantly.
No ifs and buts.
Because in his recovery, the quality of the
adult support and how he has believed him
is hugely important.
I have seen people stuck in grief.
They say, we don't talk anymore.
I told my mom once and she said,
did it really happen to you?
Then I think her window for her mother
is shut now for the rest of her
life.
So this doubles the grief.
So we must always believe them.
We must support the child.
We must praise the child.
And we must offer them reassurance that whatever
is in my hands, I'm going to make
you safe and not let it happen again.
Do not make any false promises.
But whatever is in your hands, you should
do it.
Again, I'll tell you an incident which I
saw with my own eyes.
A little child telling a little girl telling
her mother, that my relatives come and fondle
my private parts.
They put their hands on my hair.
So my mom was obviously very scared.
She said, don't tell dad.
And that was the end.
Because I had seen this around me and
I knew nothing happened after that.
So you have to offer support and take
some practical measures to show the child that
this was extremely wrong and it was not
your fault.
And I'm going to try my best to
stop this.
As important as the pathological, sexual experience, realizing
its significance is as important as it should
not be.
And it can lead to personality changes, mental
illnesses, and the child goes through after that.
It is just as important to recognize that
when a child discloses this to a parent
and if it is not properly managed, as
you are saying, then that can be equally
traumatic for the child and make the situation
from bad to worse.
Definitely.
You know, they get stuck in grief.
Even if they go for therapy, you have
a terrible time taking them out of this
abyss in which they get stuck.
Because, you know, when you are troubled, we
go to our elders to acknowledge our children.
Even if they get a little hurt, they
run to their parents, their parents love them,
they give them a big hug and tell
them that they are okay.
So when you go to your parents with
such a big psychological injury and you are
not getting any psychological trouble for that child.
Ma'am, if a child is not complaining
and the psychological signs that you mentioned are
not happening and the child is very young,
2, 3, 4 years old, so are there
any physical signs also that their parents should
take care of them while changing their clothes?
That they should keep checking them?
Yes, definitely.
Physical signs are very rare.
Because look at the nature of this abuse.
It's a very gentle form of abuse.
Because if an adult is abusing a 4
-year-old child, what resistance will he put
up?
So there isn't going to be any bruise
marks or any ruptures or anything like that.
But yes, rarely there may be, for example,
a sexually transmitted infection, pruritus, or something like
that.
But it's an exception rather than the rule
really.
Right.
Ma'am, when we talk about child sexual
abuse, you indicated in the beginning that 70
% of adult illnesses are manifested in childhood
or have started in childhood.
And as you said, all the signs that
we see, pretty much any psychological illness in
children can be rooted in child sexual abuse.
But, does that mean there will be other
forms of abuse and other problems that lead
to psychological problems as well, that people need
to be wary about?
Definitely.
So if you see, trauma in children can
be, according to the WHO definition, it can
be one of any of the five types.
So there can be emotional abuse, there can
be physical abuse, it can be sexual abuse,
it can be neglect, or it can be
commercial exploitation.
And their figures are that one in four
children, WHO figures, will go through a significant
traumatic event in their childhood.
But let me tell you about this research.
There was a very interesting study called ACE
study, Adverse Childhood Event Study.
It was done in the 1990s in San
Diego.
And in an obesity clinic, and the doctor
there was treating morbidly obese people.
And he saw that some of his patients
were so resistant, they would get well and
then relapse.
So he started digging again into their histories.
A doctor took their history and I think
he asked a slightly different question, which was
probably not even listed.
And she asked her patient that when did
you have your first sexual contact?
And suddenly the patient said that I was
seven years old when my, I don't know,
uncle or whatever raped me.
And all of their eyes opened again.
And then they saw all of their patients.
And then this study, along with the CDC,
17,000 adults studied it again and saw
their childhood.
You know, this is such an interesting and
such a groundbreaking work.
We must all know about this.
They saw that the children who were traumatized
had not only mental health issues, but also
physical illness.
They also had a lot of suicidality.
And their behavioral risk behaviors were very high.
The risky behaviors for their health, like smoking
and things like that.
And they never reached their life potential.
So this is known as the ACE study.
And according to their figures, 67% of
those people had a traumatic event, not just
sexual abuse, but a traumatic event.
The WHO has 1 in 4.
This becomes 2 out of 3.
So if there are 3 people sitting here,
2 of us have gone through their figures.
And their health conditions are surprisingly, you know,
40 health conditions which include chronic obstructive pulmonary
disease, heart diseases, diabetes, cancer.
So you name any disease and they've kind
of linked it to trauma in childhood.
it's a big study and that's why it's
quite a big thing now in your states.
That's why people are talking of prevention now.
But these physical health conditions.
Before we move on to prevention, if we
try to see is there particular environments, household
structures, certain elements that are predominant around the
kids or within the kids that predispose them
to such an event taking place.
Is there something that raises the likelihood of
abuse in kids?
So think of a child as a little
plant.
So plant will only be good if we
give it water, sun, and manure.
Similarly, a child will only be good and
strong if their home environment is good.
So if parents don't love their child and
don't give respect to their child, don't give
time to their or if they have mental
health issues or if they have a punitive
attitude or if they have authoritarian parenting like
they are very controlling and they just order
and they don't listen to the child's perspective.
So if there is any harsh parenting or
disorderly or disorganized patterns in the house, obviously
the product of that house will not be
so strong will not be able to gain
their full potential or stop such events or
trauma.
So definitely parenting has a huge role and
that's why you know I'm so interested in
parenting and we are working on that also.
attachment also plays a role.
So the children who don't have a good
attachment with a trusted adult or are insecure
they also become victims easily.
Then those children who are already going through
mental health conditions like anxiety they also cannot
protect themselves.
So our home is the first micro environment
that a child is exposed to and it
is the most important and I think that's
where the whole story begins of our lives.
If we get a good grounding or foundation
then we can avoid mental health issues and
we grow up as strong individuals and if
we don't get a then
So we would like you to
clarify how to prevent this.
How can we prevent We all know that
any parent cannot keep a camera they
can play with their friends or with their
cousins, so how can this be balanced?
Yes, so prevention is obviously the most important
thing that we need to all know.
So I think if we divide it into
general and specific measures, so in general, what
we have just discussed, that a good parenting
and a good grounding is needed for the
child.
And apart from this, I would go a
bit further and talk about the societal attitudes.
So in our society, this male patriarchal mindset
is so deep-rooted.
And just try and relate this with *
abuse.
You know, if the men are more powerful
and they can get away with anything, more
so in villages perhaps.
I think we will all agree that there
is male patriarchy in our society.
So until that doesn't change, I think, you
know, so basically the attitudes or thinking of
the society, which is such a difficult thing
even when I talk about it, how to
address it, but that is very important.
And related to that is the entitlement of
male sexuality in some way.
For example, if I have a boy, I
would let him go out and come late,
you know, at home.
But I wouldn't let my girl go out.
So we give a very implicit entitlement that
you can get away with everything.
You can do what you want.
I'm not going to be very firm about
it.
So I think when we are talking about
prevention, sometimes we go straight to the coursebook
and tell good touch, bad touch.
You know, that's not going to be very
effective.
So we have to start at a broader
level and give messages on the media and
through other means of, you know, addressing this
pathological, I would say, mindset, which our society
has adopted through dramas or whatever.
We have to get out of this.
Or put equality of genders and respect for
women and respect for children.
We don't respect our children.
Even when we are growing up, we are
just supposed to be there and listen to
the elders.
So we don't respect our children.
We don't respect our children's choices.
Are we respecting their individuality and their ambitions
and their passions?
We don't.
We just trust them.
So all these things in which we are
growing up, generation after generation, we are producing
products that grow with this mindset that adults
have the power, they are always right and
they can do what they want.
And speaking of social, speaking of social ills
that predispose an entire society or children of
a society to child sexual abuse, the amount
of taboo that is put on sexuality as
a topic of discussion, sexuality is equal to
bad.
*, bad.
That's like almost a given.
To the point that even if somebody hasn't
experienced child sexual abuse, if they have successfully
escaped through their childhood, not having experienced anything
like that, but when they get into their
marriage, then having a normal sexual relationship within
the marriage becomes a challenge because now whatever
they have held their entire life has become
a requirement.
Absolutely.
That's very right.
So our attitudes towards * are also unfortunately
pathological.
So we know that all * is not
bad.
But when we even think wrongly about *,
that it causes weakness and all that.
So I think coming to the specific measures
now, we should talk to our children.
So communication I think is hugely important between
a parent and a child about everything in
their lives, including * and * abuse.
So taking into account the child's developmental level
and the opportunity that you get, you could
be giving little messages through pictures and stories
or through your words or through your actions.
What is *?
What is good *?
What is bad *?
What is abuse?
And what are their rights?
They have the right to say no.
We have to empower them.
We don't tell our children their rights.
So talking to our children and keeping this
communication open all the time and talking about
* or * education or good touch, bad
touch and secret touch concepts, we don't tell
them.
And there is a big stigma about it.
I think recently after the Zainab case, the
Punjab government has put things in a syllabus.
I haven't had the opportunity to see them,
but there are some that are starting now.
So I think this is very important because
knowledge is power.
And your eyes don't see what your mind
doesn't know.
So if our children don't know, how will
they do it?
So definitely communicating is very important.
And second, as you said, we can't supervise
our children all the time, but I think
the golden rule is that you shouldn't sit
quietly on the one-child-one-adult equation.
If there is a group of children with
a tutor or any adult, that's safer.
But as it happens many times, we send
them for tuition, or parents have gone out
and left them with a servant.
There's a one-child-one-adult.
That shouldn't happen.
But yes, obviously we have to give our
children the freedom and the confidence to explore
on their own.
But I would still emphasize that don't leave
your children alone.
You should know he's in the garden, he's
playing and he's safe.
Now you don't have to stand on his
head, but you just need to know where
your child is.
The one-child-one-adult, as much as
we possibly can, we need to avoid this.
So to be clear, the adult, even if
it's a female, the prevention still applies.
Because another myth would be that women do
not perpetrate child sexual abuse.
Exactly.
I think that's important also because generally we
feel leaving our children with a female maid
is very safe.
But we have heard all of us so
many instances, and it's a statistical fact that
even though a minority and much less than
men, but some women will engage in child
sexual abuse.
And to tell you of my experiences, I
have heard at least two, three stories in
which a grandmother was abusing a grandchild, either
when, you know, putting her in a lap
and stroking her and things.
So I think one child, one adult is
a good rule to follow, whether it's a
male or a female.
Right.
Ma'am, when we talk about prevention in
this regard or children's child * education, a
lot of the parents want to know from
what age is it important to tell them,
when can they understand, when is it too
early or is it ever too early.
So they're very interested in knowing from what
age do we start giving them this information.
Yeah, I think that's a very practical point.
So, you know, human beings are sexual beings.
So we think that when we were teenagers,
a child who used to be asexual, suddenly
everything woke up, but it's not that.
So since a very, you know, a young,
our years since an infant, we are being
gradually exposed to what we see around us,
so what our parents are doing, how they
are behaving, what they are seeing, what's happening
on the TV.
So these things are gradually affecting us.
And I think that's when we can start
* education.
And you don't have to, you know, sit
the child in front and give a lecture.
It's while you are, for example, changing the
pamper or while you're bathing the child, you
can say, you know, you don't expose your
private parts to anybody.
So, For
example, For example, This
became very easy for me.
My first child was in England.
So it was such a sweet word, you
know, we would use it whenever we wanted
to, and there was no shame associated with
it.
So I think, So don't associate shame with
that word.
So either you can use the anatomical word
or your colloquial language.
And be comfortable with it.
So he wanted to tell me, when he's
washing his potty, 13-year-old boy sitting
in front of me and feeling highly uncomfortable,
just talking about his poopoo.
And I learned this word from there when
Hasan was in his nursery.
Poo-poo and wee-wee.
And they use it so comfortably.
And I think you should start at a
very young age.
And this hijab and shame is good.
We feel shame, but shame at the expense
of abuse is not good, right?
So don't think of it as shamelessness that
we talk to children.
It's just something important that you are trying
to inform your child so he can save
himself from later trouble.
So the answer to your question would be
that we start very early and find little
events and times in our life when we
just give little short messages and not make
it a serious affair.
And then, according to age, when children are
in adolescence, for example, girls are not told
about their periods, how to manage them, how
to maintain hygiene, or what changes will happen
to boys in their sexuality and puberty.
So we are all taken by surprise.
And wrong information from wrong places can lead
to more problems.
So please educate your child according to his
age.
And also, when we say that you are
not informing your child, that you are raising
awareness, you are putting ideas into the kid's
head.
So that's incredibly absurd, knowing that they are
going to find out from all the wrong
sources, all the misinformation, possibly perpetrators of abuse
can be their first informants, the first people
who tell them about sexuality.
And we definitely don't want that.
So it's best that this is done in
a controlled environment with trusted people and the
children know the right things about them.
We're not injecting anything into their head.
They are sexual as human beings, as it
is.
We're not injecting any hormones.
They produce those hormones themselves, even as kids.
So we have to put these messages out
there.
Exactly, exactly.
Just like you learn in psychiatric training that
in the beginning you are afraid of suicide
when you ask a depressed patient that I
might be putting this idea into their head.
And there was research done on this and
now it's clear that you don't put that
idea in their head and you have to
ask them.
I was looking at a study on this
as well.
They questioned teenagers that if you were given
* education would you have read this idea
in your mind or how would you feel?
So a huge majority of them said that
we would have led a better teenage sexual
life had we been advised or told by
our parents.
So I think there's no danger of...
And especially with the environment now that every
little child has a phone in his hand
and access to the internet and all kinds
of sites and things.
So there's absolutely no way you can save
them from the load of information that they
have around themselves all the time.
So it's better that you sit down and
give them controlled and good information and develop
trust with the child so that he trusts
you and considers you his friend.
You don't judge him.
So communicate with him, listen to him and
tell him.
And ma'am, do you advise that when
a child is coming home from school or
from work or from playing with friends do
you advise that parents ask him in plain
simple language, straightforward that did anyone do anything
to you?
Did anyone touch you?
Did anyone hurt you?
Did anyone abuse you?
Do parents need to ask their children from
time to time, not every day but from
time to time so that they have a
general idea?
It's a good general rule that when your
child comes home from school you should ask
him, how was your day?
Now it's up to the children because usually
they don't tell you.
I would always ask my son from Islamabad
to Pindi what happened today?
He would never tell me.
I don't know if the child would tell
you but it's a nice first question to
ask your child.
If he doesn't tell you, you should tell
him what you did today.
So it's always good to know what your
child has done through his day in the
school.
And yes, if you suspect that something happened
now we don't want to raise too much
alarm that we are in a normal school
day where there are 20-30 children in
the class and we don't want to ask
such direct questions unless there is an after
school activity and we suspect something.
But I think in a general talk you
will get a flavour.
Small children don't directly come and tell they
will give you a hint in their play.
You will see in their play that they
are doing such activity with their doll which
we said is a red flag that if
you observe over-sexualized activity in any age
group then it becomes important for you to
ask.
It's also probably important to know what is
an appropriate sexual activity which is a sign
of abnormality.
Because we will find people who would get
alarmed when their 12-13 year old girl
is having a crush on a boy and
that would certainly be oh my god, this
is some pathology going on right there.
That's what it is.
It's supposed to be.
That being there is normal.
If that wasn't there that would have been
a problem.
We move on to the questions with this.
One of the questions that came on earlier
into the show.
Natasha Tariq is asking is it possible to
see no long-lasting signs in children who
faced abuse?
The child showed signs of fear but once
the source of abuse was removed and the
abuse stopped, the child forgot about it.
What should be done if these memories come
back when the child is older?
Can it then cause psychological harm once they
are older and understand and realize what happened
when they were younger?
I think it just disappeared so probably the
visible signs of some altered behavior that they
had observed disappeared but believe me, the memory
stays there.
So once our memories begin to be formed
which is around 3 years or something like
that, we remember so many things and we
remember what we remember but the defense mechanism
of suppression or repression is that the painful
memories are suppressed in a corner but they
remain there and they may be sparked off
any time later in life but even when
they are suppressed I wouldn't call that child
perfectly healthy because it's like pushing the dust
under the carpet so it's still there and
causing some degree of distress or having effects
on their personality or their stress coping or
other things and the second part of the
question is if they remember later so obviously
always we haven't had time to talk about
treatment but sexual abuse events need to be
treated and resolved
and that also raises a lot of questions
in people's head psychiatric treatment psychotherapy what will
it do?
even if we go for treatment it's not
going to undo what has already taken place
so how is that going to help?
So I think the objective is not to
undo or erase the memory because that's not
possible but we do come, the objective of
treatment is to reach a point of resolution
that his father died 10 years ago but
even now when we talk about it tears
fall from his eyes and he becomes extremely
insecure and unhappy so we if the intensity
of the sorrow is not reduced then it
means the trauma is not resolved so through
therapy our objective is not to forget our
objective is to process it and the negative
cognitions guilt, shame worthlessness correct it and if
the behaviours are bad low self-esteem correct
it and bring that event to a resolution
and treat the branches of it correct Ma
'am one last question I think we can
close with this there will be a lot
of people who have experienced child sexual abuse
perhaps to a significant extent for a long
duration of time but they do develop into
productive healthy individuals with respect to their personalities
as well that we also see in our
society so is that important to highlight that
there is a should that pathology be a
necessary consequence of an abusive experience No, I
think that's very very important and we must
close at a positive message and by no
means would I mean that people who have
gone through this will be scarred for life
or will be unproductive individuals it's only that
we have to come to terms and resolve
this trauma and the negative effects that it
has caused and then maybe sublimate it with
your defence mechanism anger or negative energy positive
so look at the people who have done
big things in their fits of anger they
have used that energy so definitely we are
not just survivors we have to become thrivers
we need to thrive and move ahead and
use it to our you know use it
for our benefit some of the patients I
was talking and a lady said that if
I hadn't done this maybe my children would
have been affected now I've become such a
vigilant parent so she was using her traumatic
event as a power position not to a
pathological extent of over protectiveness but just the
knowledge that it brings that I shouldn't leave
them and take care of them so we
have to take advantage of this definitely the
individual deserves it for himself to succeed in
life we even have positive role models in
our society Nadia Jamil coming out with her
personal experiences and then using that and her
public persona as a means to get the
information out there perhaps far more than most
like all psychiatrists combined getting the awareness out
there so one person's suffering but they're finding
meaning in that suffering allowed for them to
perhaps prevent thousands of other people going through
the similar experience definitely I think it takes
a lot of strength to do that and
I really applaud her effort I wish we
could do more together with such like people
and celebrities so that we can spread this
information Thank you so much ma'am for
joining us and giving us your time and
all that discussion and information that you shared
thank you so very much for being here
Thank you ma'am it was a pleasure
to be with you thank you Allah Hafiz
Alright people this concludes our discussion for today,
child sexual abuse this is Azam and Yusuf
we were honored by Dr. Aisha with her
presence today thank you all for being with
us thank you for your questions and comments
and viewership please pass this message on let
other people know we may be preventing a
lot of people from going through very traumatic
experiences Alright, thank you very much Allah Hafiz