- Email: [email protected]
Drawings by child victims of incest
Chid Abuse & ,Veg/m, Vol. 9. pp. 183-189. 1985 Pnnted in the U.S.A. All nghts reserved.
0145-2134/L? 53.00 + .m Copyright 6 1985 Pergamon Press Ltd.
DRAWINGS BY CHILD VICTIMS OF INCEST
ALAYNE YATES, M.D. Chief of Child Psychiatry, Associate Professor of Psychiatry and Pediatrics, The University of Arizona, Arizona Health Sciences Center, Department of Psychiatry, 1501 North Campbell Ave., Tucson, AZ 85724
LARRY E. BEUTLER, PH.D. Professor and Chief of Clinical Psychology, Department of Psychiatry, Arizona Health Sciences Center
MARJORIE CRAGO, PH.D. Research Assistant, Department of Psychiatry, Arizona Health Sciences Center Abstract-Art
is an expression of the child’s inner reality. Drawings by child victims of incest might be expected to differ from drawings by other children presenting at a child psychiatry clinic. This study compares drawings by child victims of incest with drawings by children referred to the University of Arizona Child Psychiatry Clinic for nonsexual issues. Each drawing was rated on I5 dimensions, including sexualization of the figure, degree of dependency, quality of ego defenses, and adequacy of impulse control. Child victims of incest were judged to have more poorly developed impulse controls and a defensive structure which emphasized repression. These children were also significantly more variable than their counterparts in the degree to which they expressed sexual features in the drawings, but were less variable in their rated maturity and in the rated adequacy of their ability to use sublimation as a defense against anxiety. R&me-L’activitt artistique exprime souvent le monde interieur de l’enfant. On pour& s’attendre que les dessins faits par des enfants victimes de relations incestueuses soient diKerents des dessins des autres enfants qui frequentem une policlinique de psychiatric infantile. Les auteurs ont done compare les dessins d’enfants victimes d’inceste avec les dessins d’enfants rtferts a la consultation pour des raisons non sexuelles. Chaque dessin a ttt evaluC selon 15 criteres incluant le degre de representation sexuelle darts le dessin. le degre de dbpendance, la qualitt des defenses du moi, et la qualite du controle des impulsions. I1 est apparu que les enfants victimes d’inceste avaient un controle de leurs impulsions moms bon et une structure defensive qui portait surtout sur la repression. Les enfants victimes d’inceste exprimaient les caracteristiques sexuelles dam leurs dessins de facon plus variable que les autres enfants. Par contre, ils Ctaient plus stables darts leur degrt de maturite et darts leur capacite d’utiliser la sublimation en tam que defense contre l’angoisse.
INTRODUCTION ART IS AN EXPRESSION of the child’s inner reality. Young children draw what they know rather than what they see: A portrait of mother is the same whether she poses for it or not [I]. Each picture, be it scribbled in haste or meticulously traced, is a statement of the child’s internal knowledge as colored by the affective state and associations. Tasks such as drawing a person [2] or drawing the whole family doing something [3] have become valued techniques in the armamentarium of child evaluators and therapists. 183
184
Alayne Yates. Larry E. Beutler and Marjorie Crago
The drawings by children with emotional problems differ from the productions by healthier youngsters. The human figure drawings by disturbed children have significantly more indicators of emotional discord, such as tiny fingers, big hands, and omission of the mouth, than the drawings by well-adjusted pupils [2]. Young, emotionally disturbed children can be differentiated from young, well-adjusted children on the basis of systematic scoring of the kinetic family drawing [4]. However, all major authors caution against the use of emotional indicators in isolation without considering the gestalt of the drawing, the child’s age, sex, intelligence, family background and neurological status [l-3, 51. Thus, although quantitative scoring is essential in establishing normative expectations and the empirical validity of the method, in a clinic situation drawings by children are more likely to be interpreted holistically in terms of a particular child interacting with a very special environment. Drawings by child victims of incest might be expected to differ from the drawings by other children presenting with a similar degree of disturbance. In this culture, children rarely draw the genitals. Koppitz [2] lists the depiction of genitals as significantly associated with aggressiveness and as more frequent among children with emotional problems. Di Leo [l] associates portrayal of the genitals with various behavior disorders; he further states: In thousands of drawings by latency children, this writer has collected only half a dozen specimens on which the penis or vulva has been clearly specified. The reasons for this unusual addition are to be found in experiences that have made the child precociously aware of the high emotional charge invested in the sex organs.
When young children are exposed over time to intensely erotic experiences, they exhibit marked and persistent sexual interests and activities, a finding which is consistent with the hypothesis that the sexual response is learned [6]. Therefore child victims of incest might be expected to sexualize their drawings more than youngsters not involved in incest. Although a number of studies indicate that incest does not necessarily cause emotional damage [7-lo], child victims of incest drawn from court-identified samples commonly do present with behavioral or emotional difficulties. These disturbances may be less related to the sexual activity directly than to the anger or deprivation commonly found in these families and the anxiety attendant upon the family’s disruption [Ill. Thus, court-identified children who are referred for treatment may present with a similar degree of emotional disturbance as the rest of the clinic population although they are likely to exhibit some unusual sexual concerns and behaviors. This hypothesis is supported by evidence that adult psychiatric patients with a history of incest do not differ greatly from patients without such a history [ 121. This study compares the drawings by child victims of incest to the drawings of a randomly chosen sample of children referred to the child psychiatric clinic for other complaints. We anticipated that, compared to disturbed children who were not victims of incest, child victims of incest should show more body concern, sexual preoccupation and primitive defenses.
METHODS The sample consisted of 18 girls who were incest victims ranging in age from 3.5 to 17 years, and 17 girls who were disturbed but not incest victims. The comparison group was matched for age and socioeconomic background. The comparison group of girls ranged in age from 4 to 17 years. Mean ages were 11.5 (SD = 3.97) and 11.2 (SD = 3.67) respectively. All the child victims of incest were heterosexually involved girls who had been identified by the court and referred for assessment and individual or group therapy. The two samples were randomly selected from a group of figure drawings collected in the course of child and adolescent evaluations over a period of several years. All children who were evaluated in the clinic routinely were asked to draw a person. The imbalance in the sample was the product of
Drawings by child victims of incest
185
an initial clerical error and a subsequent lack of comparable control data gathered during the study period. We elected to retain the entire sample in the interest of preserving the attained
equality in the matching characteristics of the two groups. Subjects in the two groups were of upper middle to lower middle class background and all represented children who were initially referred for psychiatric evaluation and treatment. Projective drawings were obtained from each of the children but the manner in which the drawings were obtained varied somewhat as a function of the clinical judgment of the psychiatrist doing the initial evaluations. The majority of the drawings represented a single human figure with the exception of the two in the incest victim group and one in the comparison group in which two human figures were depicted. Eighteen characteristics of potentially disturbed functioning were extracted from the clinical literature and a rating scale was developed for each. This list was reduced to 15 dimensions when item analysis indicated that certain categories could not be distinguished. All projective drawings were rated on the basis of the subjective clinical impression of two clinical psychologists who possessed five and eleven years of post doctoral experience, respectively. The raters were blind as to the children’s involvement in incest. The psychologists rated each drawing on 15 dimensions: the degree of sexualization (separately analyzed for male and female figures), level of maturation, tendency to confuse various feelings and impulses, and the adequacy of certain defense mechanisms. Raters also indicated what characteristics of the drawing they used in rating each dimension. Final scores on each dimension were obtained by combining the ratings from the two clinical raters in the manner suggested by Strahan [ 131. This methodology was selected because of its ability to stabilize dimensions when such ratings are potentially of low reliability. RESULTS Group differences on the 15 patient dimensions were analyzed by a series of r tests by pairs. Differences in variability were assessed with F tests. Table 1 presents the means and standard deviations of the groups on each of the 15 dimensions. One will note that the groups produced only two significant differences. These differences were observed on the scales comparTable 1. Child Victims of Incest and Comparison Children on Fifteen Dimensions: Means and Standard Deviations Dimensions 1. Hyposexualization (failure to attend to sexual features) 2. Hypersexualization (over elaboration of sexual features) a. Male sexuality b. Female sexuality 3. Degree of immaturity 4. Level of anxiety 5. Control of impulses 6. Amount of confusion between sexual and aggressive impulses 7. Amount of confusion between love and anger 8. Quality of rationalization 9. Quality of compartmentalization 10. Quality of projection 11. Quality of acting out defenses 12. Quality of somatization 13. Quality of denial 14. Quality of repression 15. Quality of sublimation *p < .05
Child victims of incest
Comuarison Children
t
.67 ( .96)
1.18 (1.40)
1.26
.78 (1.02) .06 ( .16) .3l ( .43) .89 ( .81) 2.08 ( .67) .83 ( .71)
.38 ( S7) .09 ( .26) .21 ( .31) 1.23 (1.32) 2.18 ( .47) 1.32 ( .68)
1.40 44 .79 “94 .47 2.08’
.39 ( .68) .31 ( .39) .69 ( .81) .81 ( .77) .94 ( .87) 1.36 (1.16) .25 ( .39) .86 (1.03) .81 ( .73) .l9 ( .42)
.56 ( .6l) .26 ( SO) so ( .7l) .79 ( .97) .56 ( .77) 1.09 (1.02) .32 ( .47) 1.24 (1.11) 1.53 ( .94) .53 ( .82)
.78 .27 .76 .04 1.38 “74 .51 1.04 2.55’ 1.53
AlayneYates,Larry E. Beutlerand Majorie Crago
186
ing the victims of incest and non-victim girls on dimensions of impulse control and quality of repressive defenses. Additionally, there were significant group differences in the dispersion of ratings on the dimensions of hypersexualization, [F (1, 16) = 3.15; p < .05], maturity [F (1, 16) = 2.64: p < .05] and quality of sublimation as a defense [F (1, 16) = 3.72; p < ,051.Girl-victims of incest were more variable in their tendency to exaggerate sexual features of figures when drawing and earned less variable ratings both in maturity and adequacy of sublimation.
DISCUSSION The current findings suggest that there are relatively few mean differences between girls who are incest victims and the comparison group on the various dimensions rated in this study. Two significant differences did emerge and suggest that girls who are incest victims are somewhat lacking in repressive defenses and control of impulses when compared with girls who have not experienced incest. It must be remembered, however, that all of these children were referred for psychiatric reasons and therefore neither the absence of nor presence of differences can be taken to reflect psychological “normality” among these children. The mean differences in the degree to which repression and impulse control are utilized may be interpreted in concert with the significant differences which appeared in the variability of the two groups. For example, poorly developed repression may be implicated in girl incest victims’ tendency to be variable in the degree to which they over or under represent the sexual characteristics of figures when drawing. It makes little difference, however, whether the figure is male or female. Explicit depiction of the genitals is present in younger (Figure 1) as well as older (Figure 2) children. Moreover, the tendency concomitantly to be more homogeneous in rated maturity and quality of higher level defenses (e.g., sublimation) may suggest some deficiencies in the breadth of skills needed for interpersonal relationships. However, differences in variation may also have been an artifact& product of a more heterogeneous subject pool for the incestuous group than was true for the control subjects. The heterogeniety of the sample of incest victims may be related to a referral bias. Workers in the field may
” \
’ I\
Figure 1. Explicit depiction of genitals in drawing of young victim of incest.
Figure 2. Explicit depiction of genitals in drawing by older victim of incest.
Drawings by child victims of incest
187
assume that incest necessarily connotes emotional damage severe enough to warrant treatment, thus referring relatively healthy youngsters as well as those with behavioral and emotional problems. The incest victims studied were all girls who had been involved in heterosexual incest with a father or stepfather. The fact that they tended either to exaggerate (Figure 3) or minimize (Figure 4) sexual features of figures suggests that these children may highly cathect the sexual aspects of the partner and may also need to defend against these sexualized interests and impulses. This is consonant with the senior author’s earlier observations that children can learn to become sexually responsive at a tender age and that the degree of eroticization is dependent upon the intensity and duration of the exposure. The sexual interest and activity remains patterned upon the early experience, be it homosexual, heterosexual, oral-genital, anal, etc. [14]. As the culture at large discourages children’s sexual interests and activities, these eroticized youngsters are often rejected because of their precocious sexuality [6]. This rejection may occur both because they have difficulty in repressing sexual fantasies and in controlling their impulses. On the basis of their drawings, child incest victims may experience more difficulty in establishing themselves in an age-appropriate (mature) relationship with others, and they are frequently unable to use the defense of sublimation. When sublimation is employed, it does tend to be somewhat stronger than age-related counterparts, suggesting that sublimation is an exceedingly important defense for some such children. If they can acquire the ability to sublimate, they rely upon it heavily but if they cannot, they may appear immature and inadequate. Current estimates are that between 4% and 12% of adult women in this country have been involved in a long-term incestuous relationship during childhood or adolescence [ 10, 15, 161. Perhaps 10% of these cases are ever reported [ 171 which suggests that there is a considerable selection bias. Reported cases tend to involve multiproblem families marked by alcoholism, divorce, mental disorder, and other social problems [ 18, 141.The deficiency in impulse control
Figure 3. Exaggeration of sexual features as depictedby girl involved in incest with father or stepfather.
Figure 4. Minimization of sexual features as depictedby girl involved in incest with father or stepfather.
188
Alayne Yates, Larry E. Beutler and Marjorie Crago
which distinguishes our sample of child victims of incest could be part of the selection bias, i.e., the impulsive child is more likely to reveal the incest. Conversely, the child incest victim who is able to sublimate would be less likely to report incest. Therefore, a truly random sample of all children involved in incest might reveal a greater number of children who rely upon sublimation and fewer children with immaturity and a deficiency in impulse control. Because of the many methodological difficulties with the current project, including the nonstandardized administration of projective devices by a physician who was aware of the reason for referral and the small sample size, the results provide little more than speculative information about the effects of incest upon children. However, the paucity of literature on the subject underlines the value of even these preliminary findings. The current data suggests that incest interferes with the child’s ability to utilize repression and control impulses. Moreover, incest seems to exaggerate the child’s sensitivity or insensitivity to the sexual characteristics of others and may cause some constriction both in the dimensions of maturity and higher level cognitive defenses. In light of the foregoing suggestions, additional studies are needed in which more objective, highly defined research hypotheses and dependent variables are applied to the study of incest. It is probable, for example, that the impact in incest involves may variables other than the sexual act itself: The degree of coercion, the character of the parents, the quality of the relationship between the adult and child, the intensity and duration of the incestuous relationship, the presence or absence of other siblings, and the attitude of the family and society towards such an act should all be considered. The longitudinal, multidimensional evaluation of larger samples will be required to clarify these complex relationships. Given the problems of reliability and validity in projective assessment, future research must combine objective and subjective evaluation procedures. Standardized tasks, with standardized scoring methods, applied to matched and stratified samples over time can supplement the use of softer projective assessment in defining and extending the current findings. Only by evaluating such children on a normative as well as an ipsitive-longitudinal dimension, can definitive answers be obtained. Thus, we may come to understand the impact of incest upon a child’s development.
REFERENCES 1. DILEO, J. H. Children’s Drawings as Diagnostic Aids. Brunner/Maz.el, New York (1973). 2. KOPPITZ, E. M. Psychological Evaluation of Children’s Human Figure Drawings. Grune & Stratton, New York (1968). 3. BURNS, R. C. and KAUFMAN, S. H. Actions, Styles, and Symbols in Kinetic Family Drawings: An Interpretive Manual. Brunner/Mazel, New York (1972). 4. MYERS, D. V. Toward an objective evaluation procedure of the Kinetic Family Drawings (KFD). Journal of Personality Assessment 42~358-365 (1978). 5. REYNOLDS, C. R. A quick-scoring guide to the interpretation of children’s Kinetic Family Drawings (KFD). Psychology in the Schoofs 15:489-492 (1978). 6. YATES, A. Sex without Shame: Encouraging the Child’s Healthy Sexual Development. William Morrow, New York (1978). 7. GAGNON, J. and SIMON, W. Sexual Encounters between Adults and Children, SIECUS Study Guide No. 11. SIECUS, New York (1970). 8. LUKIANOWICZ, N. Incest-I: Paternal; II: Other types. British Journal of Psychiatry 120:301-313 (1972). 9. LANDIS, J. T. Experiences of 500 children with adult sexual deviation. Psychiatric Quarterly 30:91-109 (1956). 10. FINKELHOR, D. Sexually Victimized Children. Free Press, New York (1979). 11. CONSTANTINE, L. The effects of early sexual experience. In: Children and Sex, L. L. Constantine and F. IM. Martinson (Eds.). Little Brown, Boston (1981). 12. MEISELMAN, K. C. Incest: A Psychological Study of Causes and Effects with Treatment Recommendations. Josey-Bass, San Francisco (1978). 13. STRAHAN, R. F. More on averaging judges’ ratings: Determining the most reliable composite. Journal of Consulting Clinical Psychology 43~587-589 (1980).
Drawings by child victims of incest
189
14. YATES, A. Children eroticized by incest. American Journal of Psychiatry 139:482-485 (1982). 15. LANDIS, J. Experiences of 500 children with adult sexual deviation. Psychiatric Quarter& Supplement 30:91- 109 (1956). 16. GAGNON, J. Female child victims of sex ofTenses. Social Problem 12: 176-192 (1965). 17. FRANKLIN. R. Incest in the middle class differs from that processed by the police. Clinical Psychiatry News
March (1974). 18. ROSENFELD, A., NADELSON, C., KREIGER, M. et al. Incest and sexual abuse of children. Journal American Academy of Child Psychiatry 16:327-339 19. BROWNING, (1977).
(1977).
of the
D. H. and BOATMAN, B. Incest: Children at risk. American Journal ofPsychiatty 134:69-72
0145-2134/L? 53.00 + .m Copyright 6 1985 Pergamon Press Ltd.
DRAWINGS BY CHILD VICTIMS OF INCEST
ALAYNE YATES, M.D. Chief of Child Psychiatry, Associate Professor of Psychiatry and Pediatrics, The University of Arizona, Arizona Health Sciences Center, Department of Psychiatry, 1501 North Campbell Ave., Tucson, AZ 85724
LARRY E. BEUTLER, PH.D. Professor and Chief of Clinical Psychology, Department of Psychiatry, Arizona Health Sciences Center
MARJORIE CRAGO, PH.D. Research Assistant, Department of Psychiatry, Arizona Health Sciences Center Abstract-Art
is an expression of the child’s inner reality. Drawings by child victims of incest might be expected to differ from drawings by other children presenting at a child psychiatry clinic. This study compares drawings by child victims of incest with drawings by children referred to the University of Arizona Child Psychiatry Clinic for nonsexual issues. Each drawing was rated on I5 dimensions, including sexualization of the figure, degree of dependency, quality of ego defenses, and adequacy of impulse control. Child victims of incest were judged to have more poorly developed impulse controls and a defensive structure which emphasized repression. These children were also significantly more variable than their counterparts in the degree to which they expressed sexual features in the drawings, but were less variable in their rated maturity and in the rated adequacy of their ability to use sublimation as a defense against anxiety. R&me-L’activitt artistique exprime souvent le monde interieur de l’enfant. On pour& s’attendre que les dessins faits par des enfants victimes de relations incestueuses soient diKerents des dessins des autres enfants qui frequentem une policlinique de psychiatric infantile. Les auteurs ont done compare les dessins d’enfants victimes d’inceste avec les dessins d’enfants rtferts a la consultation pour des raisons non sexuelles. Chaque dessin a ttt evaluC selon 15 criteres incluant le degre de representation sexuelle darts le dessin. le degre de dbpendance, la qualitt des defenses du moi, et la qualite du controle des impulsions. I1 est apparu que les enfants victimes d’inceste avaient un controle de leurs impulsions moms bon et une structure defensive qui portait surtout sur la repression. Les enfants victimes d’inceste exprimaient les caracteristiques sexuelles dam leurs dessins de facon plus variable que les autres enfants. Par contre, ils Ctaient plus stables darts leur degrt de maturite et darts leur capacite d’utiliser la sublimation en tam que defense contre l’angoisse.
INTRODUCTION ART IS AN EXPRESSION of the child’s inner reality. Young children draw what they know rather than what they see: A portrait of mother is the same whether she poses for it or not [I]. Each picture, be it scribbled in haste or meticulously traced, is a statement of the child’s internal knowledge as colored by the affective state and associations. Tasks such as drawing a person [2] or drawing the whole family doing something [3] have become valued techniques in the armamentarium of child evaluators and therapists. 183
184
Alayne Yates. Larry E. Beutler and Marjorie Crago
The drawings by children with emotional problems differ from the productions by healthier youngsters. The human figure drawings by disturbed children have significantly more indicators of emotional discord, such as tiny fingers, big hands, and omission of the mouth, than the drawings by well-adjusted pupils [2]. Young, emotionally disturbed children can be differentiated from young, well-adjusted children on the basis of systematic scoring of the kinetic family drawing [4]. However, all major authors caution against the use of emotional indicators in isolation without considering the gestalt of the drawing, the child’s age, sex, intelligence, family background and neurological status [l-3, 51. Thus, although quantitative scoring is essential in establishing normative expectations and the empirical validity of the method, in a clinic situation drawings by children are more likely to be interpreted holistically in terms of a particular child interacting with a very special environment. Drawings by child victims of incest might be expected to differ from the drawings by other children presenting with a similar degree of disturbance. In this culture, children rarely draw the genitals. Koppitz [2] lists the depiction of genitals as significantly associated with aggressiveness and as more frequent among children with emotional problems. Di Leo [l] associates portrayal of the genitals with various behavior disorders; he further states: In thousands of drawings by latency children, this writer has collected only half a dozen specimens on which the penis or vulva has been clearly specified. The reasons for this unusual addition are to be found in experiences that have made the child precociously aware of the high emotional charge invested in the sex organs.
When young children are exposed over time to intensely erotic experiences, they exhibit marked and persistent sexual interests and activities, a finding which is consistent with the hypothesis that the sexual response is learned [6]. Therefore child victims of incest might be expected to sexualize their drawings more than youngsters not involved in incest. Although a number of studies indicate that incest does not necessarily cause emotional damage [7-lo], child victims of incest drawn from court-identified samples commonly do present with behavioral or emotional difficulties. These disturbances may be less related to the sexual activity directly than to the anger or deprivation commonly found in these families and the anxiety attendant upon the family’s disruption [Ill. Thus, court-identified children who are referred for treatment may present with a similar degree of emotional disturbance as the rest of the clinic population although they are likely to exhibit some unusual sexual concerns and behaviors. This hypothesis is supported by evidence that adult psychiatric patients with a history of incest do not differ greatly from patients without such a history [ 121. This study compares the drawings by child victims of incest to the drawings of a randomly chosen sample of children referred to the child psychiatric clinic for other complaints. We anticipated that, compared to disturbed children who were not victims of incest, child victims of incest should show more body concern, sexual preoccupation and primitive defenses.
METHODS The sample consisted of 18 girls who were incest victims ranging in age from 3.5 to 17 years, and 17 girls who were disturbed but not incest victims. The comparison group was matched for age and socioeconomic background. The comparison group of girls ranged in age from 4 to 17 years. Mean ages were 11.5 (SD = 3.97) and 11.2 (SD = 3.67) respectively. All the child victims of incest were heterosexually involved girls who had been identified by the court and referred for assessment and individual or group therapy. The two samples were randomly selected from a group of figure drawings collected in the course of child and adolescent evaluations over a period of several years. All children who were evaluated in the clinic routinely were asked to draw a person. The imbalance in the sample was the product of
Drawings by child victims of incest
185
an initial clerical error and a subsequent lack of comparable control data gathered during the study period. We elected to retain the entire sample in the interest of preserving the attained
equality in the matching characteristics of the two groups. Subjects in the two groups were of upper middle to lower middle class background and all represented children who were initially referred for psychiatric evaluation and treatment. Projective drawings were obtained from each of the children but the manner in which the drawings were obtained varied somewhat as a function of the clinical judgment of the psychiatrist doing the initial evaluations. The majority of the drawings represented a single human figure with the exception of the two in the incest victim group and one in the comparison group in which two human figures were depicted. Eighteen characteristics of potentially disturbed functioning were extracted from the clinical literature and a rating scale was developed for each. This list was reduced to 15 dimensions when item analysis indicated that certain categories could not be distinguished. All projective drawings were rated on the basis of the subjective clinical impression of two clinical psychologists who possessed five and eleven years of post doctoral experience, respectively. The raters were blind as to the children’s involvement in incest. The psychologists rated each drawing on 15 dimensions: the degree of sexualization (separately analyzed for male and female figures), level of maturation, tendency to confuse various feelings and impulses, and the adequacy of certain defense mechanisms. Raters also indicated what characteristics of the drawing they used in rating each dimension. Final scores on each dimension were obtained by combining the ratings from the two clinical raters in the manner suggested by Strahan [ 131. This methodology was selected because of its ability to stabilize dimensions when such ratings are potentially of low reliability. RESULTS Group differences on the 15 patient dimensions were analyzed by a series of r tests by pairs. Differences in variability were assessed with F tests. Table 1 presents the means and standard deviations of the groups on each of the 15 dimensions. One will note that the groups produced only two significant differences. These differences were observed on the scales comparTable 1. Child Victims of Incest and Comparison Children on Fifteen Dimensions: Means and Standard Deviations Dimensions 1. Hyposexualization (failure to attend to sexual features) 2. Hypersexualization (over elaboration of sexual features) a. Male sexuality b. Female sexuality 3. Degree of immaturity 4. Level of anxiety 5. Control of impulses 6. Amount of confusion between sexual and aggressive impulses 7. Amount of confusion between love and anger 8. Quality of rationalization 9. Quality of compartmentalization 10. Quality of projection 11. Quality of acting out defenses 12. Quality of somatization 13. Quality of denial 14. Quality of repression 15. Quality of sublimation *p < .05
Child victims of incest
Comuarison Children
t
.67 ( .96)
1.18 (1.40)
1.26
.78 (1.02) .06 ( .16) .3l ( .43) .89 ( .81) 2.08 ( .67) .83 ( .71)
.38 ( S7) .09 ( .26) .21 ( .31) 1.23 (1.32) 2.18 ( .47) 1.32 ( .68)
1.40 44 .79 “94 .47 2.08’
.39 ( .68) .31 ( .39) .69 ( .81) .81 ( .77) .94 ( .87) 1.36 (1.16) .25 ( .39) .86 (1.03) .81 ( .73) .l9 ( .42)
.56 ( .6l) .26 ( SO) so ( .7l) .79 ( .97) .56 ( .77) 1.09 (1.02) .32 ( .47) 1.24 (1.11) 1.53 ( .94) .53 ( .82)
.78 .27 .76 .04 1.38 “74 .51 1.04 2.55’ 1.53
AlayneYates,Larry E. Beutlerand Majorie Crago
186
ing the victims of incest and non-victim girls on dimensions of impulse control and quality of repressive defenses. Additionally, there were significant group differences in the dispersion of ratings on the dimensions of hypersexualization, [F (1, 16) = 3.15; p < .05], maturity [F (1, 16) = 2.64: p < .05] and quality of sublimation as a defense [F (1, 16) = 3.72; p < ,051.Girl-victims of incest were more variable in their tendency to exaggerate sexual features of figures when drawing and earned less variable ratings both in maturity and adequacy of sublimation.
DISCUSSION The current findings suggest that there are relatively few mean differences between girls who are incest victims and the comparison group on the various dimensions rated in this study. Two significant differences did emerge and suggest that girls who are incest victims are somewhat lacking in repressive defenses and control of impulses when compared with girls who have not experienced incest. It must be remembered, however, that all of these children were referred for psychiatric reasons and therefore neither the absence of nor presence of differences can be taken to reflect psychological “normality” among these children. The mean differences in the degree to which repression and impulse control are utilized may be interpreted in concert with the significant differences which appeared in the variability of the two groups. For example, poorly developed repression may be implicated in girl incest victims’ tendency to be variable in the degree to which they over or under represent the sexual characteristics of figures when drawing. It makes little difference, however, whether the figure is male or female. Explicit depiction of the genitals is present in younger (Figure 1) as well as older (Figure 2) children. Moreover, the tendency concomitantly to be more homogeneous in rated maturity and quality of higher level defenses (e.g., sublimation) may suggest some deficiencies in the breadth of skills needed for interpersonal relationships. However, differences in variation may also have been an artifact& product of a more heterogeneous subject pool for the incestuous group than was true for the control subjects. The heterogeniety of the sample of incest victims may be related to a referral bias. Workers in the field may
” \
’ I\
Figure 1. Explicit depiction of genitals in drawing of young victim of incest.
Figure 2. Explicit depiction of genitals in drawing by older victim of incest.
Drawings by child victims of incest
187
assume that incest necessarily connotes emotional damage severe enough to warrant treatment, thus referring relatively healthy youngsters as well as those with behavioral and emotional problems. The incest victims studied were all girls who had been involved in heterosexual incest with a father or stepfather. The fact that they tended either to exaggerate (Figure 3) or minimize (Figure 4) sexual features of figures suggests that these children may highly cathect the sexual aspects of the partner and may also need to defend against these sexualized interests and impulses. This is consonant with the senior author’s earlier observations that children can learn to become sexually responsive at a tender age and that the degree of eroticization is dependent upon the intensity and duration of the exposure. The sexual interest and activity remains patterned upon the early experience, be it homosexual, heterosexual, oral-genital, anal, etc. [14]. As the culture at large discourages children’s sexual interests and activities, these eroticized youngsters are often rejected because of their precocious sexuality [6]. This rejection may occur both because they have difficulty in repressing sexual fantasies and in controlling their impulses. On the basis of their drawings, child incest victims may experience more difficulty in establishing themselves in an age-appropriate (mature) relationship with others, and they are frequently unable to use the defense of sublimation. When sublimation is employed, it does tend to be somewhat stronger than age-related counterparts, suggesting that sublimation is an exceedingly important defense for some such children. If they can acquire the ability to sublimate, they rely upon it heavily but if they cannot, they may appear immature and inadequate. Current estimates are that between 4% and 12% of adult women in this country have been involved in a long-term incestuous relationship during childhood or adolescence [ 10, 15, 161. Perhaps 10% of these cases are ever reported [ 171 which suggests that there is a considerable selection bias. Reported cases tend to involve multiproblem families marked by alcoholism, divorce, mental disorder, and other social problems [ 18, 141.The deficiency in impulse control
Figure 3. Exaggeration of sexual features as depictedby girl involved in incest with father or stepfather.
Figure 4. Minimization of sexual features as depictedby girl involved in incest with father or stepfather.
188
Alayne Yates, Larry E. Beutler and Marjorie Crago
which distinguishes our sample of child victims of incest could be part of the selection bias, i.e., the impulsive child is more likely to reveal the incest. Conversely, the child incest victim who is able to sublimate would be less likely to report incest. Therefore, a truly random sample of all children involved in incest might reveal a greater number of children who rely upon sublimation and fewer children with immaturity and a deficiency in impulse control. Because of the many methodological difficulties with the current project, including the nonstandardized administration of projective devices by a physician who was aware of the reason for referral and the small sample size, the results provide little more than speculative information about the effects of incest upon children. However, the paucity of literature on the subject underlines the value of even these preliminary findings. The current data suggests that incest interferes with the child’s ability to utilize repression and control impulses. Moreover, incest seems to exaggerate the child’s sensitivity or insensitivity to the sexual characteristics of others and may cause some constriction both in the dimensions of maturity and higher level cognitive defenses. In light of the foregoing suggestions, additional studies are needed in which more objective, highly defined research hypotheses and dependent variables are applied to the study of incest. It is probable, for example, that the impact in incest involves may variables other than the sexual act itself: The degree of coercion, the character of the parents, the quality of the relationship between the adult and child, the intensity and duration of the incestuous relationship, the presence or absence of other siblings, and the attitude of the family and society towards such an act should all be considered. The longitudinal, multidimensional evaluation of larger samples will be required to clarify these complex relationships. Given the problems of reliability and validity in projective assessment, future research must combine objective and subjective evaluation procedures. Standardized tasks, with standardized scoring methods, applied to matched and stratified samples over time can supplement the use of softer projective assessment in defining and extending the current findings. Only by evaluating such children on a normative as well as an ipsitive-longitudinal dimension, can definitive answers be obtained. Thus, we may come to understand the impact of incest upon a child’s development.
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