Project report: ‘Signals and Signs’: Children, Medics and Child Sexual Abuse in the Family

Post-doc project report from Ruth Beecher: ‘Signals and Signs’: Children, Medics and Child Sexual Abuse in the Family

 In 1980, Patricia Beezley Mrazek informed readers of the Journal of Child Psychology and Psychiatry that: “Mental  health  professionals  and  physicians  are  often  reluctant  to  inform  the police and court  of child sexual abuse cases, especially if the perpetrator  is within  the family,  because  of  the  severity  of  criminal  prosecution  and  consequent  family  disruption.” She explained that experts Giarretto (1976) and the Kempes (1978) “maintained  that  the  law enforcement  authorities  must  be  involved  in  cases  of incest,  but they  advocate  the use of deferred  prosecution  or probation  while rehabilitation  efforts  are being made. Only if treatment  is unsuccessful  would  the criminal  process resume, leading perhaps to  incarceration.”[1]

Mrazek was the Assistant Director of the National Center for the Prevention and Treatment of Child Abuse and Neglect in the US when her article was published in the Journal of Child Psychology and Psychiatry. She was a clinical social worker who had spent time as a Fellow at the Tavistock Clinic in London. We can assume that her views on adult perpetrators of intrafamilial child sexual abuse were not considered controversial. However, it is likely that the notion of deferring police involvement whilst attempting “rehabilitation efforts” would be denounced today, at least in public.

I am a post-doctoral research fellow employed at Birkbeck, University of London and I work as part of a wider research group funded by the Wellcome Trust to explore sexual violence, medicine and psychiatry under the leadership of Professor Joanna Bourke. My strand of the research is a history of the ways medics have responded to (or ignored) the possibility that a child is being sexually abused by a family member. How have their thoughts, behaviours, public utterances, and clinical practices changed over time?

In the US and the UK, the expectation that medics will play an important role in preventing, identifying and treating child abuse was established at least fifty years ago. Health professionals working in community services – health visitors and public health nurses, family doctors and paediatricians, accident and emergency staff, psychologists and psychiatrists working in to community settings – have always had privileged access to children and families. And yet, children and adult survivors say that they are not “heard” when they try to disclose or send out “signals” or “signs” that all is not well with them.[2]

In the US, the publication of “The Battered Child Syndrome by paediatrician C. Henry Kempe in 1962 stimulated an increased concern about child abuse.  By 1968, reporting laws for child abuse were in place in every state. In the UK, the first ‘battered babies’ guidance appeared in 1970 and child abuse came under renewed scrutiny with the Inquiry into the 1973 death of Maria Colwell, starved and beaten by her stepfather. At the same time, sexual desire, pleasure and the boundaries of what was permissible and what was taboo became part of the wider public conversation. Feminists drew attention to the darker side of sex, and fought for protection against rape, and wife and child ‘battering.’ Incest was increasingly identified and disclosed by adult ‘survivors.’ Fifty years later, sexual assault is again a lead story. Adult women disclose via #MeToo. News reports publish accounts of children sexually abused now or in the past.[3]

National inquiries are underway into institutional sexual abuse in churches, children’s homes, and football clubs but most child sexual abuse happens in a child’s or perpetrator’s home. We hear little about intrafamilial abuse but it is estimated to account for about two-thirds of all child sexual abuse in England. It is estimated that only one in eight victims of child sexual abuse come to the attention of statutory authorities. It is often years before this type of life-changing abuse is disclosed by the victim/ survivor, during which time they can be repeatedly subjected to sexual violence.[4]

My aim is to bring a historical perspective to a problem that is often seen only in a particular cultural moment. It includes a comparative analysis between the US and the UK where cultural attitudes and professional learning often call back and forth, but the medical and social welfare institutions and structural contexts are very different. I will examine primary care medical responses to intrafamilial child sexual abuse within the wider social and cultural context, as opposed to the treatment they are more often given which is legalistic and procedural. The project also gathers new primary sources through its oral history and engagement components which will provide greater insight into how professionals have felt and behaved and the context for their emotions, attitudes and professional cultures in relation to child sexual abuse within the family. Therefore, this study takes can acknowledge the challenges for medics in understanding and responding to child sexual abuse without minimising the immediate and long term harm to children.

Do contact me at if you are interested in the project.


[1] Patricia Beezley Mrazek, “Sexual Abuse of Children,” Journal of Child Psychology and Psychiatry 21, no. 1 (1980).

[2] Health professionals have few disclosures in either the UK or the United States. Debra Allnock, Pam Miller, and National Society for the Prevention of Cruelty to Children, “No One Noticed, No One Heard : A Study of Disclosures of Childhood Abuse” (London: NSPCC, 2013)., 23; The National Center for Victims of Crime, ”Statistics on Disclosure of Child Sexual Abuse,” 2011, accessed 20.11.2018,

[3] C. Kempe et al., “The Battered-Child Syndrome,” JAMA 181, no. 1 (1962).

[4] Children’s Commissioner, “Protecting Children from Harm: A Critical Assessment of Child Sexual Abuse in the Family Network in England and Priorities for Action,” (2015).

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s