Cushing’s? Inconclusive. What’s Next?

The endocrinologist’s office phoned late today with Nichelle’s test results. Her cortisol levels were 24 one day, and 35 another, well within what’s considered to be a normal level.

The tests did find an elevated PTH (human parathyroid hormone) level, and lowered calcium and vitamin D levels. He’s interested in verifying a vitamin D deficiency. (This makes me wonder if he suspects hyperparathyroidism, but that’s just a guess on my part.)

We’re both very, very disappointed. Cushing’s certainly wouldn’t have been a good thing, but it would have offered something we don’t have at present: treatment possibilities. This leaves us without much of a clue as to where to proceed. Nichelle is determined to find a clinic in Boston (or anywhere, really) that will make every effort to get to the bottom of this. Her symptoms continue to be severe, and worsening. (Although they have become slightly more predictable—many mornings are often somewhat tolerable for up to a couple of hours, but the swelling continues to worsen steadily, and pain episodes occur repeatedly throughout the day.)


I was encouraged by the memory of this Scripture-inspired song I learned in Ejido Constitución, México. (Unfortunately, I couldn’t remember one line and a couple of words, and, although I have the lyrics written down somewhere, I couldn’t find them. … After almost giving up, it seems this is two choruses combined into one song. The latter part I found here.)

Jehová es mi Pastor, nada me faltará;
Jehová es mi Pastor, nada me faltará;
El cuide de las aves, la Biblia dicé asi,
Jehová es mi pastor, nada me faltará.

Nunca, nunca, nunca me ha dejado,
Nunca, nunca, me ha desamparado,
Ni en la noche oscura, ni en el día de prueba
Jesucristo nunca me desamparará.

(Jehovah is my Shepherd, I shall lack nothing;
Jehovah is my Shepherd, I shall lack nothing;
He cares for the birds, the Bible says,
Jehovah is my Shepherd, I shall lack nothing.

Never, never, never has He left me,
Never, never, never has He abandoned me;
Not in the dark night, nor in the day of testing,
Jesus Christ will never abandon me.)

Hope Deferred (for a Day)

12Hope deferred maketh the heart sick: but when the desire cometh, it is a tree of life.

Proverbs 13:12 (KJV)

Despite our best planning, we spent from 1:30 to 6:00 today not being seen by the endocrinologist. (But it’s not really his fault.)

13Now listen, you who say, “Today or tomorrow we will go to this or that city, spend a year there, carry on business and make money.” 14Why, you do not even know what will happen tomorrow. What is your life? You are a mist that appears for a little while and then vanishes. 15Instead, you ought to say, “If it is the Lord’s will, we will live and do this or that.”

James 4:13-15 (NIV)

What happened was this:

Nichelle and I arrived at the Dartmouth-Hitchcock Medical Center in Manchester about 9 minutes behind schedule. We’d made one wrong turn, which cost us about four minutes. We tried calling, but no one answered before we were actually headed up the driveway.

For the record, until we actually arrived there, we didn’t know we were going to a medical center. We thought our destination was a doctor’s office of some kind. That was our undoing.

We rushed inside (guessing on an entrance) and started waiting in line. In less than a minute, Nichelle asked a staff member for where we should go. She directed us to another counter down the hall. When we got there, the counter was unstaffed. We decided to follow the signs to the main lobby, and met another staff member on the way who said we needed to register.

We were served fairly quickly at the registration desk. They only had to correct Nichelle’s first name and her last name (yes, Michelle Wilcott :: sigh ::), and look up the insurance three times, ask for her birthdate twice and mine once, then run the co-pay.

Then they sent us upstairs, where we checked in again and sat down. After a few minutes, Nichelle was called, and the nurse explained that we checked in too late for the appointment. I was struck instantly by an unusually strong mixture of extreme disappointment and rage. I actually turned and walked away for about 10 seconds.

They did say that if the next patient did not show up, they would let us in, so we waited. Nichelle spent the next 15 minutes with her head down and eyes closed. I spent that 15 minutes reading, rubbing Nichelle’s back, wishing there were something I could do to help, and mentally reviewing verses about God’s sovereignty.

The nurse came out, and told us the next patient had arrived. She listened to our story, and noted that similar problems had occurred recently, and went back in to find us the number for the medical center person who handles such problems.

During the ride home they phoned us to make another appointment; we were grateful able to get one tomorrow—at the same time of day, but in Concord, rather than Manchester.

I’ll have to take another afternoon off from work, but can make up the time later in the week, or take it as sick time (our company policy allows this; I’m not being a weasel).

God knows what He is doing. It is comforting to know Nichelle will be seen by someone who doesn’t squeeze patients in, but rather insists on giving them proper attention and time.


Nichelle has a new symptom. We’re not sure what they are caused by—they might be tiny hemmorages under the skin—but in several places she’s had tiny, dark brown, circular freckle-like spots appear. She noticed a few yesterday. This morning there were more, and this evening still more. They are definitely increasing in number. One that seems to be just forming (based on location and size) is a reddish color, which leads me to think that they are indeed tiny spots of subcutaneous bleeding. There’s also no external irritation or rash present near them.

The other symptoms, pain, dizziness, fatigue, difficulty walking, burning sensations, severe edema, stabbing pains, painful pressure in the head, etc., all continue for much of every day.

Life Is Swell

Nichelle has requested that I post a few photos to show the extent of the swelling she is dealing with. We actually have one or two photos that are worse, but she doesn’t want those posted.

Since the return of the fibromyalgia symptoms in force, about the time NaNi was weaned, Nichelle has battled rather significant swelling at various times. This winter, it became much worse. At best, the swelling is bad; typically it is horrible.

Note the dramatic difference in the leftmost photo with the middle photo. These were taken only two days apart, on December 25 and 27, 2005, respectively. These primarily show the face, but the swelling involves the whole body. On most days, the swelling is very significant, somewhere between the rightmost photo and the middle photo.

We are awaiting an endocrinology appointment in about a week. The previous endocrinologist to whom Nichelle was referred refused to see her because there wasn’t anything in her records to indicate an endocrinological problem (for the most part, until recently, the swelling hasn’t been our biggest focus). A cardiologist she visited told her, “Sometimes my patients have swelling in their legs and ankles when they return from cruises because of all the high-sodium food.” Our excellent neurologist was more perceptive. Nichelle had brought these photos in to show him—he was stunned. He also pointed out that the swelling alone can cause a great deal of pain.

Our voluntary medical advisor/patient advocate Beth suspects Cushing’s Syndrome or some form of hypercortisolism. So far, Nichelle’s symptoms are consistent with that, including stretch marks on the skin in many places, and swelling varying in degree at different times of the day.


Nichelle spent a couple of hours last night going through photos from the past three years. There are obvious periods lasting several months when the swelling was very bad, and times when it was mostly gone. In general, the very bad swelling lasted much longer than the times without. There’s also a clear increase, over time, in what we might call “base level” swelling, but even within that ever-raising baseline, there are days when it is worse than others, as the photos above show.

I had actually forgotten how much smaller she was even within the past year. No amount of exercise or dieting seemed to help, either. She lost 30 pounds (after Naomi was born) doing the South Beach Diet, and was intensely exercising for an hour every day. Neither one of these things prevented the swelling or the fibromyalgia symptoms from returning, and exercise is supposed to be a very effective long-term treatment for fibromyalgia.

I’ve created a new category on the BLOG for posts related to fibromyalgia. It’s available on the categories list at the right, or from the bottom of any post classified as such.

(See related posts: What’s Wrong with Nichelle?, The Twins Are Back: What’s Wrong with Nichelle, Continued, and Pain; or view all posts categorized as related to fibromyalgia.)

Pain

(See related posts: What’s Wrong with Nichelle?, The Twins Are Back: What’s Wrong with Nichelle, Continued, and Life Is Swell; or view all posts categorized as related to fibromyalgia.)

Beyond the significant swelling, Nichelle’s life seems to be defined ever more by pain. On Valentine’s Day she had a “good day”—the pain was only mild for much of the daylight hours, and she enjoyed being able to do some work around the house. By suppertime, though, her pain had started to return. Walking became markedly difficult. By 9:00 or 10:00 the pain was steady and even more severe.

Tonight was particularly troubling. Nichelle was feeling pretty good until late afternoon, and was looking forward to attending the midweek Bible study. At 5:30, she announced that she needed to get dinner on and then take a nap. By the time I left work, she determined that she wasn’t going anywhere. By the time I got home to pick up the kids for church, she was having severe pain in her left leg, and remained virtually immobile during the two hours we were out at church, because she (and Nichelle is not one to exaggerate) was afraid if she got off the couch, she’d fall down and not be able to get up.

About the time the kids were being put to bed, the pain became extreme. She took two of the pain medications she has been prescribed, but normally does not use. They didn’t do much. The pain in one leg spread to the other.

Then the head pains started. These were awful.

For ten minutes at a time, over the space of more than half an hour, Nichelle is racked with sharp head pains that almost defy description. Every few seconds she convulses, stiffly curling up, and manages somehow to stifle her cries of agony. Tears well up in her eyes. Her breathing becomes rapid. For a few minutes these pains subside, and then they return.

I kneel beside her, gently clutching her hand, my own body heaving with sobs I cannot control. “I love you,” she whispers quietly when the pains relent for a few moments. I weep even more.

After what the clock says is only an hour, the stabbing pains have passed. Nichelle sits up for the first time all evening.

Perhaps the rest of the night will bring some degree of comfort.

Editor’s note: Thankfully, attacks this severe don’t happen every day, but they do seem to come a couple of times a week, and similar attacks of lesser severity do come every day. The tiring, debilitating pain is there almost always, though. Nichelle took the kids to Wal*Mart on Monday night, for a very quick trip. When she got back she said, “You know, there’s no way I could make it through the [grocery] shopping.” (I knew that—it’s why I’ve been doing the grocery shopping for the past few months.)

Keywords: Fibromyalgia, swelling, severe pain

Domestic Security Consultant Visits Wilcox Home

On Friday, the Wilcox family received a long-awaited visit from Clover, a border collie who is employed as a domestic security consultant north of here.

After an intimidating first meeting, Naomi and Clover became fast friends. NaNi adopted the same pose as Clover for all their photos together. (Note that Naomi is wearing some of her new Geekwear: a “Version 2.0” t-shirt.)

More hints has said that Clover presented on such important topics as stick-fetching, ball-fetching, stick destroying, Nerf-ball chewing, human herding, neighborhood patrols, criminal background checks, and indicating when one needs to use the little dog’s room. (I am told by Matt Camillieri that other canines, such as Winnie Sohmer, are not so good at communicating such a vital topic.)

Clover is a good dog.

The Twins Are Back: What’s Wrong with Nichelle, Continued

After being without any fibromyalgia symptoms since late May, “The Twins”—Pain and Agony—are back with Nichelle.

She has had some minor pain this week, possibly connected to the return of cold weather, but we were hoping (and praying) that it would not be as severe as before.

Today she had severe pain in her feet, head, and arms. At one point, she wasn’t able to manipulate the wheel on her sewing machine.

Disappointing … discouraging.

See the entry named What’s Wrong with Nichelle for some background on Nichelle with the disease, and Pain for more information and discussion. (Or view all posts categorized as related to fibromyalgia.)

Predators: Pedophiles, Rapists, and Other Sex Offenders (Anna C. Salter, Ph.D.)—[More Than a] Book Review

Anna Salter understands how sexual predators think and operate. She has spent over two decades studying, interviewing, and treating sexual offenders and their victims. Her book, Predators: Pedophiles, Rapists, and Other Sex Offenders : Who They Are, How They Operate, and How We Can Protect Ourselves and Our Children, is an accessible, powerful work that strikes at the heart of our common misinformation and misunderstandings about sexual offenders, their behaviors, and dangers.

How Big Is the Problem?

Sexual predators. Who are they?

  • They are the man who relentlessly probes for weaknesses he can exploit to convince (or force) post-pubescent teenage girls into having sex with him. He will prey on those who are alone, have family issues, or otherwise make the mistake of trusting him. He volunteers extensively with the youth in his local church where most of his victims attend, and often sings there. Prohibitions against gossip, as well as naivete and shame, leave his crimes hidden for years. He marries, and the church staff presume incorrectly he is then “safe” from engaging in further predatory behavior.
  • They are the church worker who, when the church bus is nearly empty, fondles the vulva of a gradeschool-aged bus rider.
  • They are the homosexual man who has claimed there is nothing wrong with a sexual relationship between an adult male and a teenager. He is recommended by the church staff to direct a youth program at another church.
  • They are the adult-age brother who repeatedly fondles his preteen younger sister.
  • They are the employer who believes it is acceptable and understandable to have an extramarital affair with his older teenaged employees.
  • They are the man who consummates his marriage by, after being told by his bride that she is both exhausted and suffering from a terrible headache, declaring, “I’m getting what I deserve,” and forces her.
  • They are a respected, well-liked, family man who has been sexually abusing a neighbor for years. When the neighbor moves away, he finds a new victim—his granddaughter. In this rare case, the church he attended acted completely appropriately, working with law enforcement authorities to ensure the offender’s arrest, interviewing possible victims, and making the problem known to the congregation. (None of his offenses occurred in relation to any church activities or at the church itself.)
  • They are a man no one—not even his wife, houseguests, or closest friends—suspects of sexually abusing and raping at least one boy over many years. He chooses his victims carefully: Those already suffering from abuse at home are not likely to be acknowledged or believed, whereas those from stronger families, despite ease of access, would present too high a risk. Church work guarantees access to the former. None of those around him know he had long ago beaten one rap in California. During a later trial he will not testify, but does not realize the statements made to friends are damning when statement analysis techniques are applied.

I have not taken any of the descriptions above from Anna Salter’s excellent book; rather, I have personally known every single one of the offenders I have described. I know some—but far from all—of their victims. From my own interactions with the victims of sexual predators, I am all too aware of the destruction their abuse causes, and the years of pain the victims suffer. A few victims eventually find deliverance in one way or another. Some, rarely, will have loved ones who patiently work to rebuild what others have destroyed. Some victims seem irreparably harmed—especially those who are abused at a young age—suffering severe psychological damage that persists decades beyond the abuse.

I have intentionally omitted the many victim stories of which I am aware, and described only the predators I personally knew. I am not that old. Most of my social contacts occur within the two churches I have attended in the past 30 years. Nevertheless, I can quickly call to mind the identities of eight such abusers (and at least five more that I have known but have sparser details about). Either my life is particularly prone to intersect with sexual abusers, or the problem is far more prevalent than most people would admit. It would seem that the latter conclusion is the correct one. (Many sexual predators like to target Christians and churches, because claiming to be a fellow Christian quickly helps establish unmerited trust. However, just because most of the abusers I listed were known from a church context, one should not assume churches harbor a greater number of sexual predators than would be represented in the general population. One exception to this would be the Catholic priesthood, where the required absence of adult romantic interests; an immense amount of respect and trust in the position; easy access to children; and the Catholic Church’s consistent cover-up, rather than removal, of abusers all worked together to create an ideal environment for pedophiles.)

Sexual abuse is not new. Sexual predators are not new. Hundreds of years before Christ, God provided in the Mosaic Law legal protection for women against rape, clearly attesting to the fact that such offenses span centuries and cultures. Research as early as 1929 “documented rates of sexual abuse of female children ranging from 24 to 37 percent” (p. 11). “[R]ates of child sexual abuse are extraordinarily high.”

What’s even worse is that offenders, even repeat offenders of the most egregious type, keep getting away with it:

In treating victims since 1978, I have heard the stories over and over of offenders who were never caught. A young woman tells me that as a young teen, she and a friend were raped repeatedly by a friend of their parents. It went on for years. He would rape the girls in front of each other and threatened the lives of both of them if they told. They didn’t. They were both afraid of him and convinced they wouldn’t be believed anyway, given his high standing in the community and his friendship with their parents. There is a song she still hates, she tells me, because he used to sing it as he undressed them.

Her friend committed suicide as a young adult. My client has been plagued with low self-esteem, ongoing nightmares, and depression. She has always lived a walled-off existence, keeping others at emotional arms’ length.

And what happened to him, I ask? “Him?” she says, perplexed at the question. “Nothing. He’s still moderator of the town meetings.” There … was a predator who was bold enough to rape children in front of each other. He was implicated in the suicide of one, had damaged the life of another, and more than a decade later was standing up in front of his peers cracking jokes. And, no doubt, still singing his song. (p. 13)

Of the eight predators that I have personally known and described above, only three have faced criminal charges, and even that represents an uncharacteristically high percentage. “There are a lot of sexual offenses out there, and the people who commit them don’t get caught very often. When an offender is caught and has a thorough evaluation with a polygraph backup, he will reveal dozens, sometimes hundreds, of offenses for which he was never apprehended.” (pp. 12–13)

Dr. Salter’s book is not simplistic or light handed, and even avoids being alarmist. She approaches the subject with a rationality and thoroughness that is scarcely seen, and conveys a strong empathy toward the victims she describes. She also is not afraid to sacrifice psychology’s sacred cows in the course of defining the problem:

In the past one hundred years, psychology has twisted itself into pretzels developing theories to answer [the question of why people molest children]. Few of these theories have any research at all behind them, and many of them are little more than excuses and rationalizations for child molestation. I am not talking now about Freud’s failure to accept the victim accounts given by his patients and his turning them into “Oedipal fantasies” to avoid ostracism by his peers. That has been too well documented to deserved further comment. Nor am I talking about cases where memory of abuse was lost and then recovered, although there is considerable evidence that this can occur.

What is actually more perplexing in the history of psychology is the attitude toward cases in which it was known and acknowledged that the abuse took place. In the early part of the century, psychoanalytic writers maintained steadfastly that sexual abuse was the fault of the child, not the adult … (p. 51)

Dangerous Misinformation and Knowledge Gaps

There are two major knowledge gaps—or perhaps broad categories of misinformation—in the general population, and even in the criminal justice system population: How skilled sexual predators are in deception; and how harmful sexual abuse is toward those who are abused.

There are other knowledge problems as well. Some of these, such as the idea that pedophilia is not immoral, merely illegal, are perpetrated by those who actively work to legalize pedophilia. Others, such as the concept that all recovered memory is incorrect, seem to take on lives of their own in the popular media and culture.

Masters of Deception

One of the things that is so puzzling, given the vast number of child sexual abuse incidents per year, is why perpetrators continue to get away with it. Even worse, why are people so willing to “forgive and forget” the actions of known offenders, blissfully ignorant of the virtual guarantee of reoffense in the long term?

The biggest reason is simply that children who are sexually abused rarely tell anyone what has happened, even when the results of the abuse are devastating. Forty percent of children who are infected with sexually transmitted diseases will deny any sexual contact.

But not all children tell in the first place. For reasons as varied as fear of the offender, shame at their helplessness, love and protection of a parent, or even—if the offender is clever enough to stroke their genitals—shame of their own sexual arousal during the sex acts—they don’t tell.

Also, they often think their silence affects only them. (p. 14)

Unfortunately, often, even revealing the abuse does not protect a child from from further abuse or protect other children from abuse by the same perpetrator (Salter, p. 14).

Another reason is that social workers and psychologists are ignorant about what to look for. They will perform an “interactional assessment,” and will watch the victims interact with their abusers. If they do not observe any fear, especially on the part of a child, or do observe what they believe is appropriate behavior on the part of the accused abuser, they conclude that the person must be innocent. Dr. Salter explains, however:

Of course, there is no research and no good theory to support this approach. I stood in a conference once when someone was discussing this type of assessment and noted the lack of research to support it. I mentioned that sex offenders are notorious for bonding with a child and using that relationship to manipulate the child into having sex with them. I stated that, in addition, a child might be afraid of the man for entirely different reasons. Perhaps he beat her mother but never laid a hand on her. What justification did the presenters have for believing that one could tell from the interaction between child and alleged perpetrator whether the abuse had occurred or not? (p. 16)

Dr. Salter explores the various techniques of deception used by sexual predators, as well as people’s inability to accurately detect deception. Surprisingly, almost no-one is good at detecting deception. Not surprisingly, almost everyone thinks that he or she is better at detecting falsehood than reality, with disastrous results. Modern tools such as statement analysis and polygraphs (when performed by a skilled interviewer) are much more accurate.

Then there is simply the double-life. Predators keep up an appearance of kindness and likability. Most of the predators I listed at the top of the article were extremely amiable. Several were extremely popular in their social groups. All of them were able to successfully project an image of fine, upstanding citizens. All of them were (and most still are) trusted by those around them. Nearly all have been praised for their fine Christian testimony.

Likability is such a potent weapon that it protects predators for long periods of time and through almost incomprehensible numbers of victims. Mr. Saylor, an athletic director in an elementary school, operated undisturbed for almost twenty years. He tells me there is almost no limit to the number of molestations that one can get away with. (p. 26)

We expect child molesters to be monsters. It seems to be contrary to human nature to think that people who project “niceness” and normality could harbor such dark secrets. (This happens for other sexual offenders as well. One court-appointed evaluator concluded that an offender could not be a rapist, because he was polite and performed such normal acts of courtesy like holding the door for her.) “But it is a misconception that child molesters are somehow different from the rest of us, outside their proclivities to molest. They can be loyal friends, good employees, and responsible members of the community in other ways” (Salter, p. 47).

[T]hose who see child molesters as monsters seem the quickest—when their neighbor, friend, or family members is accused—to say that it is definitely a false report. After all, child molesters are perverts, creeps, and monsters, and their nice neighbor/minister/father/uncle/friend/priest is not a monster. Ergo, he is not a child molester.

Once this kind of denial locks in, no amount of evidence will change their minds. A cab driver said to a colleague of mine, “Child molestation! I know all about child molestation. My father was accused of child molestation, and the children lied—all twenty-six of them.” (p. 47)

Remember that a sexual offender nearly always has to lead a completely double life. The ability to be dishonest yet convincing is a daily requirement, and practice improves that ability. One of the most terrible lessons I have had to apply in my life is essentially impossible to observe: “Never mistake for truthfulness the ability to lie with impunity.” Sexual offenders have been so convincing that they are able to fool those with the most experience. Dr. Salter notes the case of one offender who earned the trust of a correctional officer and his family to the extent that they allowed him to live with them, even though they had a nine-year-old daughter. He began molesting the daughter, and was sent back to prison for it, but even then they continued to try to visit him in prison. “The only rule for deception in sex offenders I have ever found is this: If it is in the offender’s best interests to lie, and if he can do it and not get caught, he will lie” (Salter, p. 73).

The ability to deceive is underestimated by people who are generally truthful. We do not see what we do not want to see. I have personally seen extreme examples of this. One father (whose wife I knew for years) killed his infant in an alleged accident while giving the child a bath. The same thing happened a few years later. This time he was found guilty of murder and sent to prison. Nevertheless, the man’s wife refuses to believe, against evidence and common sense, that both deaths were not accidental.

There is no cure for sexually abusive behavior. Dr. Salter agrees with the Association for the Treatment of Sexual Abusers (ATSA): “Although many, if not most, sexual abusers are treatable, there is no known ‘cure.’ Management of sexually abusive behavior is a life-long task for some sexual abusers” (p. 59).

[S]ixty out of one hundred sex offenders would still reoffend after the most effective treatment available today, and that means we are a long way from “curing” pedophilia or rape. Note also these results were for the short run. No one really knows the impact of treatment in the long run.

Another common mistake is the belief that child molesters are always themselves victims. Not all victims are offenders, and most offenders are not victims. (Salter, pp. 72–73) There is a long history in psychology of not holding sex offenders responsible for their behavior.

The behavior was, it seems, the fault of their ‘frigid’ wives or ‘seductive’ child victims. It was a symptom of family dysfunction. We mute the realization of malevolence—which is too threatening to bear—by turning offenders into victims themselves and by describing their behavior as the result of forces beyond their control. (pp. 174–175)

Most sexual offenders, especially those who abuse children, engage in a process known as grooming. According to one offender:

When a person like myself wants to obtain access to a child, you don’t just go up and get the child and sexually molest the child. There’s a process of obtaining the child’s friendship and, in my case, also obtaining the family’s friendship and their trust. When you get their trust, that’s when the child becomes vulnerable and you can molest the child….

As far as the children goes, they’re kind of easy. You befriend them. You take them places. You buy them gifts…. Now in the process of grooming the child, you win his trust and I mean, the child has a look in his eyes—it’s hard to explain—you just have to kind of know the look. You know when you’ve got the kid. You know when that kid trusts you.

In the meantime you’re grooming the family. You portray yourself as a church leader or a music teacher or whatever, whatever it takes to make that family think you’re OK. You show the parents that you’re really interested in that kid. You just trick the family into believing you are the most trustworthy person in the world. Every one of my victims, their families just totally thought that there was nobody better to their kids than me, and they trusted me wholeheartedly with their children…. (p. 42)

“Like Being Bitten by a Rattlesnake”—The Harm of Child Sexual Abuse

Childhood sexual abuse has significant long-term consequences. Even children abused at ages younger than two years, when no real memories tend to persist, are affected by the abuse. The major sequelae of sexual abuse include (from http://www.annasalter.com, as well as other sources):

  • PTSD (Post Traumatic Stress Disorder)
  • Depression
  • Anxiety disorders
  • Dissociation
  • Sexual problems
  • Traumatic worldview
  • Re-victimization

Of these, the one that seems most counterintuitive is revictimization, yet it is a considerable problem. Why would someone who has been abused allow himself or herself to be abused again? There are many reasons for this, although the mechanism is not well understood. One factor that seems clear is discussed in The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse:

When children are abused, their capacity to say no and set limits is severely damaged. So even if the abuse continued into your adult years, you are still not to blame. There is no magic age where you suddenly become a responsble, cooperative partner in sexual abuse” (Ellen Bass and Laura Davis, pp. 117–118).

Other statistically significant long-term effects of childhood sexual abuse include:

  • Needing psychotropic medication
  • Attempting suicide
  • Being battered as adults
  • Drug addiction/abuse
  • Alcoholism
  • Having sexual problems
  • Being afraid of men
  • Having fear of women
  • Reporting out of body experiences
  • Having nightmares
  • Isolation
  • Decreased sex drive
  • Dissociation
  • Anxiety attacks
  • Trouble with temper
  • Antisocial behavior
  • Prostitution

Studying the impact of child sexual abuse, Dr. Salter planned to read all the literature on the sequalae of child sexual abuse:

[B]ut that grandiose plan faded as I read for months on end without being able to tap into all the research. At the end of several months, however, I was convinced of one thing. Child sexual abuse was like getting bitten by a rattlesnake: Some kids recovered completely, and some didn’t, but it wasn’t good for anybody.

Sexual abuse will often haunt the victims for a lifetime. There is hope for those who choose to heal, but for many that choice may never be readily available. Healing can be extremely difficult and painful.

Many survivors inaccurately blame themselves for the abuse, or suffer enormous misplaced guilt in regard to the abuse. This may happen for many reasons. One is that guilt allows the survivor an illusion of power: If the survivor was at fault, he or she had the power to stop the abuse. (The same dynamics are observed in the survivors of violent assaults and other personal crimes.) The alternative is to admit that nothing the survivor could do would have stopped the abuse, and that helplessness seems like something we consciously or subconsciously avoid acknowledging.

In other cases, abusers or others—even caretakers—project their own guilt onto the survivor. Abusers often reinforce the idea that the child wanted the abuse to take place. This is especially true when the suvivor’s experiences automatic sexual arousal in response to the abuse. Others who should support the survivor often knowingly or unknowingly add to this guilt by refusing to acknowledge the abuse took place or failing to place the guilt solely on the abuser.

For some reasons, girls tend to channel their negative emotions inward, often engaging in a variety of self-destructive behaviors. The total impact is severe and frightening, and the lists above do not really do it justice.

“Trust No One”—Mitigating Risk for Our Children

Many child-safety programs focus on the danger of strangers. Although it is true that abduction and abuse by strangers does occur, most abuses are perpetrated by someone who is known to and trusted by the family of the child.

The best protection children can have is their own parents. In one sense, parents need to learn to be far less trusting than they are, and avoid situations and behavior that have no benefit. Would a child molester abuse a child when there were other children or people in the home? Yes. Some will be so bold as to abuse a child with a sleeping spouse in the same bed, and many with the spouse in the next room. Some will do it with the family watching, fondling children while in the process of wrestling with them, carrying them around, or throwing them up in the air. Learn to avoid high-risk situations. Like handling blood or body fluids that might be contaminated with HIV, our though process and actions need to reflect the possable danger in situations we formerly thought nothing about. We cannot guarantee we can protect our children from harm. There are times and places that we cannot control (such as a teacher or principal who takes kids out of the classroom and molests them at the school). “But in the majority of cases of child molestation, a parent has been conned into allowing the offender to spend time with the child. In those cases, we have considerably more of a chance to prevent it” (p. 226).

A friend called me recently. A young man has befriended the family of her son’s best friend. The young man seems particularly taken with the children in the family. In fact, he seems to adore them, and he is over at the house, mostly playing with the children, almost daily. He does not appear to have any adult love interests, male or female. He has never been married, and he does not date. My friend has met him. He seems delightful, a bit immature perhaps, but really a nice guy. Did I think there was any problem with her leaving her own son alone with this man? Would I be concerned?

You bet I would. Would I be rude to him or refuse to go out to dinner with the family if he’s along? Of course not. I have no proof that there is anything wrong with him. But would I quietly make sure my own children were never alone with him? Yes, because I know that he is in a high risk category. I would do it for the same reason that I don’t dive into pools that could hold hidden rocks. It only takes one.

I have since met this man. I like him. There is nothing about the way he talks or acts that suggests he is a child molester—which means nothing and changes nothing. I won’t leave my children alone with him. “Liking” isn’t enough for me to override what my head tells me. He is in a high-risk category, whether I like him or not. (pp. 227–228)

Dr. Salter illustrates the situations that can arise, and the social awkwardness that can arise as a result of being aware of such situations, with this experience from her own life:

I am standing at the gym at a children’s sock hop. The noise is deafening. Two hundred children are running, hopping, sliding, dancing, and whirling, all the while simultaneously shrieking at the top of their lungs. There is such a thing as a perpetual motion machine, and it is called childhood. The yelling children and the blaring rock music make me hunger for the quiet and the solace of my little fireplace and the book I left behind. Because neither of my children has given a backward glance since they headed into the fray, I began to wonder why I’m here. The mother of my daughter’s best friend had invited both of my children to come with her, but I had been reluctant to give them up. I work so much that time with my children is precious.

“This is spending time with your kids?” I think. I feel foolish and out of place. I don’t see anyone I know. I trudge grumpily over to check every twenty minutes or so just to keep track of my kids. It is a neurotic impulse, I think. What could happen in such a public place?

I find my daughter. At age six, she is dancing happily with her best friend and another girl and the other girl’s father, a man I don’t know. I wave and turn away.

Twenty minutes later I look for her again. She is still dancing with the same group. It crosses my mind that this is a little unusual. In a setting like this, her attention span is normally measured in nanoseconds, not in forty-minute blocks. Usually she has to see everybody, explore every corner of the gym. Why is she still there?

Twenty minutes later the same group is still dancing. I am uneasy now; this is simply not her pattern. I walk over and touch her arm and turn her to dance with me. Instantly the man grabs her arm and pulls her back, right out of my hands. I take her arm again, give him a look that would freeze blood, and yell, “I am her mother” over the blaring rock music. He backs off. My daughter and I and her best friend go off to dance together.

After that I keep an eye on her—and him. He ignores his own daughter, but when he thinks I am not looking, he finds mine and her best friend in a long line of kids waiting to go under a limbo pole. He looks around, then picks both of them up and throws them into the air, all the time smiling and laughing and focusing on them intently. I step up, and he slips off.

A few days later I call my daughter’s teacher. I was uncomfortable, I tell her. No other father in the room was hanging around other people’s children in that way. It was inappropriate, and if that man comes to school, I don’t want him alone with my daughter. “Funny you should say that,” she says. “He showed up for a field trip the other day. He spent so much time with another child that I thought he was that child’s parent and sent a note home to the wrong family.”

I go home and tell my nanny. Someone’s going to call, and it won’t be him. Likely it will be the child, perhaps the mom. They’re going to invite my daughter over to play. Just be ready because she isn’t going.

“What do I say?” my nanny asks, panicked. “I don’t know what to say.”

I stare at her incredulously. “Tell them she’s sick,” I say evenly. “Tell them she was abducted by aliens. Tell them she’s pulling the wings off flies or doing quadratic equations. I don’t care what you tell them. But she is never going.”

Within a week, the call comes.

I tell the parents of my daughter’s best friend because she was targeted too. Their daughter doesn’t go either—for a while. But time and social norms wear her parents down. “What could we say?” they ask me. “It was during the day. He wasn’t home. I don’t think he’d do anything during the day with the sitter there, do you?”

Maybe he won’t, I think. Maybe he isn’t even a child molester. Maybe I am wrong about this. But if he is, he will not hesitate to come home early from work, dismiss the sitter, and take a little girl’s trusting face in his hands and tell her he will teach her a new game.

I don’t know what to say to these parents. In their heart of hearts they believe what they want to believe. He is middle-class, wears a suit, goes to work every day, pays his bills, takes his family on vacation, and seems like a nice person. He is a “nice” man in their world, and niceness, they believe—they want badly to believe—is a character trait, not a decision. They are afraid of strangers. I am afraid of him. (pp. 79–80)

Should You Read Predators?

Be aware that the descriptions of sexual abuse in the book may (or perhaps should) evoke strong emotional or physiological responses. At times, the true evil exposed can be heart-wrenching or physically sickening. (I would caution those who have experienced severe sexual abuse.) It is, however, my strong recommendation that Predators be read by every parent, minister, grandparent, educator, church worker, social worker, criminal justice worker, police officer, or doctor.

Parents especially need to understand the scope of the problem, and be well informed about what risks they can easily avoid and what they should watch for in protecting their children. There is a misappropriation of effort in educating children to be aware of “stranger danger” (which is important, nevertheless), and the situational awareness parents must have to adequately perform their job of protecting their children.

For Further Reading

Although much more clinical, I have also found Dr. Salter’s Transforming Trauma: A Guide to Understanding and Treating Adult Survivors of Child Sexual Abuse to be especially helpful in understanding the long-term affects of childhood sexual abuse.

I am also digesting a number of books on healing from sexual abuse. (See my 2005 book lists.) Healing is painful, but it can and does happen.

I have also enjoyed Dr. Salter’s works of crime fiction about forensic psychology: Shiny Water, Fault Lines, White Lies, and Prison Blues.

When I finish a few more books, I’ll BLOG them as a resource guide, or add them to this entry.

Terrorists Hit London Public Transport

Earlier today terrorists detonated four bombs, three on the London Subway system (at 8:51 a.m., 8:56 a.m., and 9:17 a.m., BST) and one on a double-decker bus (at 9:47 a.m., BST). Thirty-three people were killed in the subway system, and more on the bus. Hundreds were injured.

The BBC has posted some accounts from survivors here.

I heard about this on WBUR, which was still running the BBC broadcast, while on my way to work. I was stunned. I don’t know how to react. I wondered if the past decade of quiet from the IRA had lulled Londoners into a more complacent state. I tried to imagine what it was like for the people who went through it. I wondered if these bombs were left in knapsacks like the ones used in the Madrid train bombings. If so, how would I react if I noticed a knapsack or bag left behind while on the subway? Would I even notice, or would I be oblivious, paying attention to my reading and nothing else, until the blast hit?

Terrorism is the new Cold War. I miss the old one. At least then we knew who the black hats were.

Growing up in the Cold War, I don’t think we were instilled with the idea that the Russian people were our enemies, it was just the government of the USSR and its leaders that were bent on global domination under Communism. As a late-comer to the nuclear age, I also didn’t fear nuclear holocaust. The rational insanity of MAD (mutually assured destruction) made perfect sense, and kept the peace for decades.

I’ll have to talk to my children about this. I wonder if they are fearful about what is going on in the world. David, our six-year-old hero, would probably not be afraid. He would imagine himself defusing a subway bomb before it could detonate, and single-handedly wiping out the terrorists who left it. At some point, we grow out of being afraid of things like lightning, and take on fears that are larger in scope. Isaac probably wouldn’t think about it at all, and John would probably be nervous about riding on public transport.

I don’t live in fear, but I know many people do. I do wonder what is next. There are many nasty things that we haven’t seen used by terrorist organizations. Some of them, like a bioterror attack using Spanish Influenza, are so easy that I can’t believe they haven’t been used yet. Read Richard Preston’s Demon in the Freezer, for starters.

And, since I’m on the topic, let’s stop calling the Iraqui terrorists insurgents. In our own War for Independence in 1776, we were insurgents. With the only exception being the destruction of the tea in the Boston Tea Party, our targets were strictly military. When innocent civilians are intentionally targeted (and not merely suffering in collateral damage), that’s terrorism. Why are we afraid to use the word?

And what do the terrorists want you to believe?

Life with an Anxiety Disorder

This is the post that I have put off writing for years, for one reason or another.

Let me begin by a disclaimer. An anxiety disorder does not mean that a person worries excessively about things, or, more specifically, the anxiety that an anxiety disorder causes is not the same as “real” worry.

Let me explain. When we moved a year and a half ago, we had a surprising amount of trouble with selling our house. We had buyers back out, we had a buyer who had no job, we lost bids on houses we were attempting to buy. That produced some “real” worry on my part.

For example, during the sale of the house, purchase of the new one, and the move, I must confess, there was a certain amount of real worry. There were dozens of details that had to work out perfectly. Nichelle had gotten sick in the last week before the move, and the packing was behind schedule, even though we’d been working on it for a year. After we moved, my anxiety disorder kicked into a higher gear for about three weeks, when there was no reason for “real” worry at all. Anxiety-disorder-caused worry simply does not feel the same.

Scripturally speaking, we are not to be worriers. Everything is in God’s hands, and part of the Christian life is to trust Him. It doesn’t mean nothing bad will ever happen to us, but that God gives us grace to deal with what comes, and we can depend on Him to provide that.

History of My Anxiety

In October of 1995, I awoke one morning in a state of what I can only describe as abject terror. I had never experienced anything like this before. Even worse, unlike some people who have panic attacks, this anxiety never went away. It was with me all day, every day, for every waking moment.

I could not figure out what was wrong. Despite knowing that many such things are caused by chemical imbalances within the brain, my self-diagnostic software was offline. I concluded that this must be some sort of spiritual attack.

As I look back now, I can see that I had fairly long periods of heightened anxiety about certain situations throughout my youth, probably starting at age 8 or 9; I will discuss that later.

I was in agony. I was able to work, operating WordSmith Digital Document Services full-time, although it was very difficult to concentrate. When I got home, I was exausted. I couldn’t eat much. I spent long hours on the phone, talking with my sisters Cindy and Fran. Of course, I also spent a lot of time talking to my wife, Nichelle. Fran fed me Scripture and we prayed often. Nothing seemed to work. Talking about how I felt and praying with my family helped sometimes, but nothing took away the almost always overwhelming, constant feeling of fear.

I remember a couple of things very clearly. I remember looking at Isaac, who was six months old at the time, and thinking, “I should be enjoying this time with my son, but I can’t.” I also remember once or twice, while transitioning into waking, the anxiety would not be present for just a second or two, and then it would come crashing down on me. Feeling normal for such a fleeting moment made everything worse.

Because I was not eating normally (I didn’t have food anxieties, but had little interest in food), I lost weight. It was ironic when people would comment on how much better I looked. It wasn’t worth the price.

Occasionally, I’d get bad advice from the uninformed. My friend Mark and I boiled this down to a simple message, “You don’t have enough faith.” (We continue to tease each other in that fashioin to this day.) Many people simply don’t view the mental health realm as being biologically based. Few people would say to someone with a broken arm or influenza, “Well, just keep praying.” Praying should definitely be part of any treatment, but broken bones need to be set, and the flu is a virus the body must fight off. I am not at all saying that prayer doesn’t work, but the fact is that, although He does miraculously heal people, God doesn’t want everyone healthy; there are lessons to be learned in our infirmities, and His plan for our life may involve suffering.

After nearly six months of this, my family’s practicality sunk in, and I went to see a doctor. I didn’t really trust the fields of psychology or psychiatry (although a psychopharmacologist would, in retrospect, have done me a world of good), but I agreed to go to an internal medicine specialist, Dr. Richard Lubens, who I knew had an excellent reputation for listening to his patients.

He said, “Ah, it sounds like you have a generalized anxiety disorder. We don’t know what causes them, but there are some treatments that work very well.” He chose an older medication, partly because of its well-established history, and probably partly because I was uninsured at the time and it was inexpensive, unlike many of the newer medications.

He put me on a small dosage of amitriptylene, which is an older, tricyclic medication. Within a week I was feeling vastly improved. A week later, as a follow-up, he increased the dosage slightly.

I was normal again. Even better than normal. For the first time in my life, the things which had caused my occasional anxiety as a child stopped bothering me. I had my life back. What a blessing!

But the story does not end there.

Note: This post will be expanded over the next few days, or perhaps longer.

Topics to come:

  • Anxiety “triggers”
  • My anxiety versus panic attacks
  • Reflections on anxiety/panic during childhood
  • Current status

Marburg—Similar to Ebola

Since Monday, I have been tracking the news about an outbreak of the Marburg hemorrhagic fever, a really nasty virus, in Angola.

Try this article for some scary reading, especially the following (emphasis mine):

“The latest figures available show the disease had killed 117 out of 124 people known to be infected by Tuesday. The Centers for Disease Control and Prevention in Atlanta says the usual death rate is 23 percent to 25 percent, but few infected patients are reported to have recovered this outbreak. There is no known cure.”

Recommended Reading: The Demon in the Freezer, by Richard Preston, and The Hot Zone, also by Preston.