Institutional abuse and societal silence: An emerging global problem

Australian & New Zealand Journal of Psychiatry, 48(1) The Australian Royal Commission into Institutional Responses to Child Sexual Abuse was announced by Australian Prime Minister Julia Gillard on 11 January 2013. Examining how institutions with a responsibility for children ‘have managed and responded to allegations and instances of child sexual abuse and related matters’ (Australian Government, 2013) arguably represents the most wide-ranging attempt by any national government in history to examine the institutional processes (or lack thereof) for addressing such abuse. Its frames of reference are very wide: The Commissioners can look at any private, public or non-governmental organisation that is, or was in the past, involved with children, including government agencies, schools, sporting clubs, orphanages, foster care, and religious organisations. This includes where they consider an organisation caring for a child is responsible for the abuse or for not responding appropriately, regardless of where or when the abuse took place. (Australian Government, 2013) The phenomena of individuals, or groups of individuals, associated with institutions using their roles to further their sexual abuse of children or to assist in the cover-up of such practices will necessarily be illuminated by the Royal Commission. When the national inquiry was announced, there were no less than three state-based inquiries dealing with child abuse planned or underway in Australia, one in Queensland, one in Victoria, and a just-announced inquiry in New South Wales. It is a testament to the enduring and tenacious use of power by those associated with societal institutions that, in a global sense, it has really only been within the last two decades that the world has witnessed progressive revelations involving many instances of individuals or groups from such institutions sexually abusing children. This is notwithstanding a demonstrated palpable resistance on the part of the many institutions to cooperate in the uncovering of such crimes or the prosecution of those responsible. Research demonstrates that approximately two-thirds of both inpatients and outpatients in the mental health system report a history of childhood sexual and/or physical abuse (see Read et al., 2004 for an extensive review). If emotional abuse and neglect are added to the mix, the percentage reporting an adverse/traumatic childhood becomes even higher. The Adverse Childhood Experiences (ACE) Study, a pioneering United States epidemiological survey, has provided retrospective and prospective data from over 17,000 individuals regarding the effects of adverse events, including child abuse, during the first 18 years of life. This enormously significant ongoing study demonstrates the enduring, strongly proportionate, and frequently profound relationship between adverse childhood experiences and emotional states, disease burdens, high-risk sexual behaviour, self-destruction, drug abuse, health risks/healthcare costs and early death, even decades later (Felitti and Anda, 2010). Furthermore, a recent detailed review found that child sexual abuse is intimately related to increased risk for poly-victimization, social stigmatization and impaired attitudes towards the self and the social world (Olafson, 2011). A sizeable proportion of victims with childhood abuse experiences present to medical and psychiatric systems and receive various diagnoses which do not necessarily refer to the traumatic origin of their illness. While research on dementia, schizophrenia, bipolar disorder and depression is widely funded, grants are rarely given to study the mental health consequences of ongoing childhood trauma, which include dissociative disorders Institutional abuse and societal silence: An emerging global problem