B11: Depressive Symptoms Traced Back to Child Sexual Abuse
Updated: Nov 18
Elma and James have been married for a year. To many of their friends, they are a happily married young Christian couple. Notwithstanding, Elma came to see me complaining of having depressive symptoms like unwillingness to wake up from bed in the morning, always feeling down, and not wanting to talk to anyone throughout the day. As we dialogued more, she came across to me as someone with a rather low self-esteem, making comments like “In fact, I’m not happily married. After all, I don’t deserve it.”
Upon further clarification of her last statement, she said, “I am a dirty person. How can a dirty person deserve to be happily married?” As evidence of her dirtiness, she said that whenever she touches her panties, she has to wash her hands at least three or four times. This is because she feels her hands have now become dirty and so she keeps on washing them several times.
Instead of adopting the appropriate psychological protocols to help her manage her depressive symptoms, I decided to pursue further to trace the root cause of her “dirty” self-concept and see if there is a deeper link between the so-called “damage goods syndrome” and her presenting complaints.
I started by exploring her current relationship with her husband. She disclosed that she has difficulty in getting intimate with him. In particular, during sex, she is “turned off” but just accommodates his advances. When asked what would have caused her to be like this, she thought for a long while and then revealed that it may have something to do with a sexual abuse incident during her childhood.
When I probed deeper, she revealed that this happened when she was about eight years old. Her parents had gone out of the house and the living hall was fairly dim in the twilight hour of the evening. She was home alone with her cousin and three other boys from the neighborhood, just talking and sharing jokes.
Her cousin then suggested doing something more interesting like playing a game. He said to the group, “Let’s pretend that we are attending a fashion show, and let’s have Elma undress down to her panties and walk around a few times as though she is a famous model in her birthday suit.” Alma recalled “Immediately, everyone started to clap and cheered me on. At first, I was reluctant but they were insistent. Finally, since it was already quite dark, I gave in.”
She continued, “After walking two rounds in the hall, suddenly, there was a bright light on the car porch. My parents had returned home! I quickly ran to my room and hid. But it was never the same again. Suddenly, I felt ashamed and being used. It affected who I am and I grew up unconfident of myself.”
That shame and lack of confidence took an adverse psychological toll on her as an adult. Besides having difficulties in forming intimate and trusting relationships with others, even with her husband, she is full of self-blame for not having the courage to say “no” but going all out to please others. She is now particularly fearful of dim places as they remind her of the hall where the abuse incident happened. As a result, she is often in isolation, culminating in her depressive moods.
As part of the intervention, I started the process of psycho-educating Elma that her depressive symptoms are the manifestations of natural defense mechanisms at work to suppress the guilt and shame of childhood sexual abuse from surfacing. To avoid feeling that pain, she is unconsciously taking all the evasive actions to stay away from any potential triggers but the over-use of the avoidance defense mechanism resulted in a sense of hopelessness and melancholy outwardly expressed as depressive symptoms.
The neuroscience aspects of our memories
Elma’s trauma of childhood sexual abuse was internalized and stored in her memories. Memories are formed by the reactivation of a specific group of nerve cells called neurons through the persistent changes in the strength of connections between them. The persistent change in the strength of the connections is termed synaptic plasticity. Neurons that fire together wire together.
Past toxic shame memories can be restructured through the creation of healthy reparative memories as alternative routes for the synapses to travel on when the shame or guilt is triggered. The good news is that we can create healthy alternative memory routes without reliving those events in real life.
Indeed, neuroscience researchers have found that mental imagery can change our multisensory perceptions. In other words, our imagination can create reality at the neuronal level. To be effective, shame memory reframing through imagery has to be experienced as real as possible. The “experiencing” is key for effectiveness.
The healing process
I then recommended to Elma that Memory Reframing Psychotherapy (MRP) can help her recover from the long-term repercussions of her childhood sexual abuse. MRP is a psychodynamic technique to restructure the negative memories of the past trauma into something positive so that the use of defense mechanisms becomes unnecessary.
In the secular world, EMDR (Eye Movement Desensitization and Reprocessing Therapy) is a psychological technique recognized by WHO (World Health Organization) as the most effective approach to address sexual trauma. The MRP, which is a form of inner healing in Christian terminology, is the closest to the EMDR.
Indeed, the purpose of MRP is to repair the trauma of the original experience of the abuse to create through mental imagery a favorable memory out of the same past scene as an alternative route for the memory synapses to travel.
Rescue and comfort
After explaining to Elma the process involved in MRP and getting her informed consent to proceed with it, I prayed with her to invite the presence of God and then asked her to relax, close her eyes, imagine herself walking into her past memories and enter into the original scene of her sexual abuse.
Following my lead, she described the hall of the house, the furniture settings, the dim surroundings, and the four boys watching her as she paraded around the sofas clad only in her panties. She recalled that initially, she felt quite fun as everyone was happy and cheering her on, but when the car of her parents shone light from the porch into the hall, she was overwhelmed with shame and she quickly ran to her room. While she was re-experiencing the intense emotions generated by her past memories, I could see tears flowing from her closed eyes.
Very gently, I asked Elma to imagine bringing Jesus into her midst to rescue and comfort her. Instantly, she said she could visualize Jesus laying His hands on her head and telling her that He had set her free from the toxic memories of her sexual abuse. She recalled that His eyes were full of love. He gave her a wide smile and nodded His head with an approving acceptance. Elma said she sensed something dark left her, a certain “light-heartedness” came upon her, and with that, Jesus left the room as suddenly as He had appeared to her.
During the debriefing, Elma mentioned that when she was reflecting on her encounter with Jesus, she briefly opened her eyes. Strangely, the whole counseling room was very dim although in reality, it was quite well lighted. She would normally feel very fearful as such a dim setting would trigger the memories of the sexual abuse. But this time, there was no fear at all. I thought something very positive had taken place and I asked her to report any other improvements at our next session.
Indeed, Elma was excited to tell me one week later that since the MRP, she noticed she had been washing her hands only once after touching her panties instead of several times. She was also surprised that she met up with some of her friends during the mid-week rather than avoiding them. I am convinced that we have addressed the underlying dynamics of her presenting issues and from this juncture, I proceeded to help her manage those depressive symptoms that she initially complained about. (For more details on this protocol, you can watch SSC’s teaching Video V01 on Addressing Depression, accessible at https://www.youtube.com/watch?v=3CBf8nSNpqs.)
Dr. Edmund Ng
10 Sep 2023
Corresponding SSC monthly teaching video: V11 – Helping Sexually Abuse Children at https://www.youtube.com/watch?v=-LbAe1JVPJE
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