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Knowing the perpetrator of Child Sexual Abuse

 http://tns.thenews.com.pk/knowing-perpetrator/#.WqJhO-hubIW

There is no single profile for a perpetrator of child sexual abuse

Knowing the perpetrator

He is a normal-looking person, leading a seemingly normal life. His eyes are not crazed. He is not unkempt. He has a job and has normal social interactions. There is no apparent sign of a mental disorder. Yet a dark secret lurks behind the shadows — he is a child sexual abuser. There is no formulaic profile that fits a perpetrator of child sexual abuse. There is no way even an adult can identify him or her, leave alone a child. Seven-year-old Zainab of Kasur fell prey to one such felon whose crime remained invisible till Zainab was found, albeit too late.

As Pakistan grapples in the wake of this shocking incident, it is time to raise awareness not just about the crime but also about the criminal who is often imperceptible.

“There is no single profile for a perpetrator of child sexual abuse because not every child sexual abuser is a pedophile. Pedophilia is a disorder and a specific sexual preference; it is a sickness,” says Dr Asha Bedar, clinical psychologist, trainer and researcher, who has worked extensively with cases of child sexual abuse.

As Pakistan grapples in the wake of this shocking incident, it is time to raise awareness not just about the crime but also about the criminal who is often imperceptible.

In her professional experience, Bedar has seen that many perpetrators are not pedophiles. “They can be very seemingly normal and functional people who have no diagnosed mental illness. They can be respected members of the society. They can be popular in social circles, hard to detect and harder to believe to be sexual predators of children. This makes it doubly tough for children to identify them as well.”

About pedophiles, Dr Uroosa Talib, Psychiatrist and Head of Medical Services, Karwan-e-Hayat Hospital, says that they are not recognisable by appearance, speech or demeanour. “To get to the child, they develop a step by step plan. They first observe how they can build a rapport with the child. These are sharp, brutal, cruel people who will go to any length to get what they want.”

Among the celebrities who have courageously spoken up about being survivors of child sexual abuse is female actor, Nadia Jamil, who has used the platform of social media to draw attention to the issue, and toward other victims like Kainat Batool.

Jamil echoes the view of experts that there is no set profile of such a perpetrator of child sexual abuse, or a rapist. “Any man could potentially sexually abuse or molest a child. Rich men have raped and will. Poor men have raped and will. Literate and illiterate men have raped and will. Until you deal with violent and domineering stereotypes created by patriarchy, men will continue to abuse,” she says, sharing her views with TNS.

Read also: Talking point

“Pedophilia is a disease. True pedophiles are attracted sexually to pre-pubescent children in general. The urges and reasons behind the act of abuse may be different between a pedophile and non-pedophile abuser but the danger is the same — being aroused by a child,” she says, adding that not all abusers are men.

Dr Talib says the commonest emotional trauma that leads to personality disorders is child sexual abuse, even if the impact remains only as a suppressed memory or is clouded by denial. “This is one of the most difficult traumas to ever get over. The victims, in turn, can become perpetrators, and often use sex for power. Their morality changes.”

Earlier this week, the Women’s Action Forum (WAF) sent recommendations to the State, as well as to the National Commission on the Status of Women (NCSW); one of these is to conduct psychological and psychiatric evaluations of those convicted of sexual abuse and rape, including of minors.

Bedar also says that research shows that the numbers of girls and boys sexually abused is almost the same. “But due to years of social conditioning boys internalise the idea that they can protect themselves; they do not want to accept their vulnerability. Gender dynamics and abuse have a very strong connection,” she says, adding that socially generated ideas of masculinity make the boys think that ‘if I can’t be a victim than I must have been a part of it’.

Thus, many male victims grow up telling themselves that they must have consented to it, especially if the abuser was a woman. “Boys are also more vulnerable in some ways as they are outdoors more often and parents allow sons to be with strangers like drivers or helpers more readily compared to daughters.”

Evidence suggests that child sexual abuse and rape is linked to gender-based violence in general. “Strong gender role socialisation, power dynamics, myths about gender and rape, lack of strong sanctions and strong male peer support for masculinity and role modelling” are some of the dynamics Bedar feels need to be looked into.

Experts agree that the core to the solution is making the children more aware but parents are a big part of this equation. “Parents need to have a relationship and connectedness with their children that their child can come and share not just successes but also failures, so that if anything like this happens that makes the child feel embarrassed, he or she can still share it with their parents and their parents believe them,” says Dr Talib. “Giving a child the concept of religious boundaries can actually work positively. This also helps them understand the concept of good and bad touch with keeping religious sensitivities in mind. Teach your children rights over their self and the dignity of their bodies.”

Jamil says she would be wary of strange men paying too much attention to a child. “We have to teach our children to be vigilant and to protect themselves and others. Warn them. Keep an eye on them and pray hard. And we have to change the way we educate ourselves and our kids. Till the state invests in the right people…it’s up to us. One child at a time. We cannot afford to stop or give up. We will not give up.”

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Depression – Career, family life, everything suffers

In a society where mental illness is stigmatised and its treatment is expensive, the harm of not getting treatment for depression can be disastrous

Career, family life, everything suffers

Eventually, you may wander the labyrinth and keep popping pills that sometimes help you sleep and at other times are mood-lifters. By so doing, you become one of the many Pakistanis who pop millions of these “happy” pills to fight a very real and very debilitating illness.

“The total antidepressant market in Pakistan is approximately Rs4 billion, as per annual sales, and is growing at the pace of 16 per cent; the market for tranquilisers or anxiolytics is also around PKR3 billion, with a double digit growth of 10 per cent,” says Nouman Lateef, Director, BU-GI Care, Merck.

“Depression is underdiagnosed and undertreated. People suffer needlessly. On the other hand, some people are misdiagnosed and receive medications they shouldn’t,” says Dr Nadir Ali Syed, a neurologist at Karachi’s South City Hospital.

However, disagreeing with studies that indicate that between 30-50 per cent of Pakistanis are depressed, he feels the actual figure for patients in need of medical attention is closer to 10 per cent. “That is still very common. Major Depressive Disorder is remarkably common in Pakistan, as it is in the rest of the world.”

The disease chooses its prey without disparity on the basis of economics, and strikes people across the board, whether they are rich or poor. In the opinion of Dr Uroosa Talib, Psychiatrist and Head of Medical Services, Karwan-e-Hayat Hospital, the prevalence rate of mental illness is high. “1 in every 4 persons in Karachi suffers. The reasons are many. Lack of basic amenities like water and electricity, poverty, street crime, terrorism and violence,” she says, talking about the social reasons for depression.

Read also: An overdose of self-medication

Shedding light on the medical causes of depression, Dr Syed says that depression can be the primary illness or frequently also be triggered by other medical problems, such as thyroid disorders or neurological diseases. It can be related to pregnancy or menstruation or even to medications or vitamin deficiency. “All depression is neurological in the sense that it is related to brain abnormality. It is associated with changes in chemicals in the brain, such as serotonin norepinephrine or dopamine. Many neurological disorders can be a reason for depression like stroke, Parkinson’s disease, migraine headaches, dementia, or pain from any cause.”

Treatment of depression can be an expensive prospect, and mental healthcare providers are not readily accessible. “In Karachi, Jinnah Hospital and Civil Hospital have psychiatric facilities. Other public hospitals just have OPDs,” says Dr Talib.

Treatment of depression can be an expensive prospect, and mental healthcare providers are not readily accessible for the underprivileged. “In Karachi, Jinnah Hospital and Civil Hospital have psychiatric facilities. Other public hospitals just have OPDs that prescribe anti-psychotics and that is not enough,” says Dr Talib, adding that treatment requires both talk therapy and medication.

Dr. Syed says the most common medicines used in Pakistan are Escitalopram, Citalopram, Fluoxetine, Paroxetine and Sertraline, sold under various brand names.

Medication to treat depression is a potential lifesaver, but must be prescribed by doctors qualified to prescribe them. “Most of the medicines sold over the counter are anxiolytics like Lexotanil, Xanax and Valium. These are more addictive and people use them as hypnotics,” says Lateef, talking about the popular benzodiazepines class of medicines that are used and abused readily. “Anti-depressants’ effect is not immediate; their impact takes time to show. However, a new class of anti-depressants has a quicker onset of effect.”

“A study shows that 60-65 per cent of the patients visiting primary care physicians are patients of depression and anxiety,” says Dr Talib. However, most of those coming to the general physician don’t even know what they are suffering from. “They complain of chronic symptoms like backache or fatigue, which are actually physical manifestations of depression. We go to the doctor and take medicines for physical symptoms, but not for mental illnesses.”

Females being at least twice as susceptible to depression in Pakistan, Dr Talib feels that this is because females have to carry heavier emotional loads, particularly in lower income groups. “These women are already struggling so much to survive that their stress tolerance is very low. Their families don’t understand what is happening to them. They have no one to talk to. They have no acknowledgment of emotional issues and no means to relax themselves. Multiple childbirths and hormonal fluctuation add to the problem.”

Lateef says that while prescribing an anti-depressant, the age and condition of the patient should be taken into account.

“People should never self-medicate. There are specific medications for specific patient types,” says Dr Syed.

“But instead of psychiatrists who should actually be prescribing them, they are mostly prescribed by cardiologists and general physicians,” says Dr Talib.

She also advises that one should not discontinue these medicines suddenly. “They should be tapered off, but only after the doctor weighs the pros and cons. Relapse of depression is very common so one might need a maintenance dose of the medicine for life.”

The treatment for depression is as complex as the disorder itself. Medication must be coupled with counselling and rehabilitation. Afia Wajahat, therapist, works with Mental and Social Health Advocacy and Literacy (MASHAL), in underprivileged areas of Karachi. It is an initiative linked with the Aman Foundation. Her team goes door-to-door to screen people for mental illnesses, provide them therapy, and help them get a second lease of life through rehabilitation and provision of livelihood to bring them out of the clutches of poverty.

In Wajahat’s experience, rehabilitation is most important in order to avoid a relapse. “For that we have to bring them back towards leading productive lives. We enroll them in vocational trainings, socialise with them as they have to come out of isolation, and counsel them to give them confidence.”

The harm of not getting treatment for depression can be disastrous. “We need to make people understand the consequences of depression. Your career, your family life, everything suffers,” says Dr Talib. It is time Pakistanis understand this.