Damned If You Do,Damned If You Don’t

CEA and Mental Health

CEA is arguably the most difficult form of abuse to define and cannot be understood as a single, universal phenomenon because, like all forms of interpersonal abuse, it is framed by specific social relations of gender, race, and class (May-Chahal, 2006). Nonetheless, a widely accepted definition suggests that CEA involves “a verbal assault on a child’s sense of worth and wellbeing, or any humiliating, demeaning or threatening behaviour directed toward a child by an older person” (Bernstein & Fink, 1998, p. 2). According to Glaser (2002), CEA involves a repeated pattern of damaging interactions of commission and omission that can convey a sense of worthlessness, being unloved, flawed, unwanted, or in danger or only of value in meeting someone else’s needs. Boulton and Hindle (2000) also argue that emotional abuse is an inherent part of all types of interpersonal abuse. CEA is the most common form of child abuse (Australian Institute of Health and Welfare [AIHW], 2014; Stoltenborgh, 2012) and is the most strongly linked to the later development of mental health problems (Schneider, Baumrind, & Kimerling, 2007). Estimations of the prevalence of CEA vary widely according to the definitions used and methods of measurement. In a review of studies from around the world, CEA was reported at a prevalence of 36% (Stoltenborgh, 2012). In Australia, of the 53,666 cases of substantiated child abuse between 2012 and 2013, 38% involved CEA (AIHW, 2014). Witnessing domestic violence is the most likely explanation behind the high rates of substantiated cases of emotional abuse (Holzer and Bromfield, 2008).

CEA is more commonly reported by women and girls, with twice as many girls in some studies reporting CEA compared to boys (Scher, Forde, McQuaid, & Stein, 2004). Women who have histories of CEA are also more likely to report mental health problems in adulthood (Harper & Arias, 2004). Other forms of child abuse and domestic violence are also common in the backgrounds of women who have experienced CEA (Humphreys & Thiara, 2003). Research has shown that the risk of all types of child abuse is increased in the context of domestic violence and that growing up in domestic violence can be considered an emotionally abusive experience (Holt, Buckley, & Whelan, 2008). For girls, CEA also often occurs alongside CSA (O’Dougherty Wright, Crawford, & Del Castillo, 2009), which can also be considered emotionally abusive in and of itself. Research also shows that CEA is most damaging when it occurs alongside CSA (Messman-Moore & Garrigus, 2007). CEA also increases the risk of revictimization of women in adulthood through sexual assault (Spertus, Yehuda, Wong, Halligan, & Seremetis, 2003) and domestic violence (Taylor, Boris, Heller, Clum, & Rice, 2008). However, unlike for CSA and domestic violence where most perpetrators are male and victims are female, both men and women perpetrate CEA, with fathers reported as slightly more likely to be perpetrators (Sedlak et al., 2010).

There is a sizable body of psychological research into CEA and its impact on mental health, most of it quantitative and from the United States. This research links CEA to poor mental health in adulthood, although not for all abused individuals (Glaser, 2011). Adult mental health conditions that have been associated with CEA include anxiety and depression (Spertus et al., 2003), post-traumatic stress disorder (PTSD; Spertus et al., 2003), personality disorders (Johnson, Cohen, Brown, Smailes, & Bernstein, 1999), eating disorders (Kennedy, Ip, Samra, & Gorzalka, 2007), and schizophrenia (Cheavens et al., 2005). Some psychological studies into CEA, particularly those focused on post-traumatic stress disorder (PTSD), suggest that childhood trauma leads to difficulties in emotional regulation and interpersonal relations (Schoedl, Costa, Fossaluza, Mari, & Mello, 2014). Other studies are concerned with identifying the “mediators” between abuse and mental illness, including “maladaptive schemas” such as vulnerability to harm (O’Dougherty Wright et al., 2009). These and other psychological studies also describe powerful feelings of shame, worthlessness, humiliation, and anger on the part of abused individuals (e.g., O’Dougherty Wright et al., 2009). Emotional abuse directly supplies the child with a negative sense of themselves, such as feeling? “I am worthless” (Sachs-Ericsson et al., 2010, p. 492) and can be understood as an attack on another’s psychological integrity (Krause, Mendelson, & Lynch, 2003; Schoedl et al., 2014). However, the mediators and emotions identified in this research are commonly treated as signs of psychological dysfunction and as relatively fixed cognitive and emotional “styles” in the individual, detached from any wider social context. As such, then, abused individuals become positioned in psychological discourse as psychopathological and the gendered aspects of these experiences remain hidden.

Only two studies have examined the gendered dimensions of psychological and emotional distress in CEA in an effort to explain why it appears to be more damaging to women. Harper and Arias (2004) specifically explored gender and shame in CEA in the United States. They found that women tend to experience overt shame and internalized feelings of self-blame, sadness, and depression while men experience what is referred to as “bypassed shame,” that is, avoidance or denial of shame, as well as externalized feelings of anger and hostility. The authors suggest that women are “more self-focused in response to emotional stressors” and may have a tendency to ruminate (Harper & Arias, 2004, p. 373). Also in the United States, Downs and Miller (1998) found that fathers’ physical and verbal abuse predicted mental health problems in daughters but not in sons, while mothers’ abuse did not predict problems in either daughters or sons (Downs & Miller, 1998). These findings point to differences in the perpetration and impact of CEA according to gender, but the authors do not attempt to theorize this further. As with all quantitative research into CEA, these studies use predetermined scales to group abusive behaviors together, such as “hostile rejection” in the Psychological Maltreatment Inventory (Harper & Arias, 2004) or “being insulted or sworn at” in the Conflict Tactics Scale (Downs & Miller, 1998). This means that the actual content, manner, and context of CEA are never elaborated in-depth, and what is said and done, how, by who, and in what context remain largely hidden from view. As noted earlier, there is a robust body of feminist research elaborating the gender discourses and power relations constituting other forms of gendered violence but no such feminist attention to CEA outside of research into the emotional distress experienced by children in domestic violence (e.g., Buchanan, Power, & Verity, 2013). Moreover, while social workers often provide counseling and support to women who have histories of CEA, as yet there has been no attention from within social work to the gender and other social dimensions of CEA and the implications for practice. The research reported on in this article seeks to address this gap.

Most feminist research into gendered violence and abuse is concerned solely with male-perpetrated abuse. The research reported on in this article also considers abuse perpetrated by mothers. I argue that mothers’ abuse is also constituted through gender power relations and related discourses and practices. Firstly, women continue to undertake most of the undervalued and unpaid care of children and this can result in women spending large amounts of time caring for children, with all the challenges and frustrations that this can bring (May-Chahal, 2006). Secondly, many mothers are living in domestic violence where unequal gender power relations structure the day-to-day interactions of the family, with consequences for relations between mothers and their children (Buchanan et al., 2014; Moulding, Buchanan, & Wendt, 2015). Thirdly, the finding that mothers’ abuse has less of an impact than fathers’ may reflect their reduced social power and the likelihood that their abuse is offset to some extent by continued nurturing of their children (Downs & Miller, 1998). Lastly, abuse perpetrated against girls and boys by either parent is likely to be distinctive in terms of its gendered context, content, and orientation (Moulding, 2016). However, I also argue that investigating child abuse perpetrated by mothers requires great caution because mothers already come in for far more public scrutiny of their parenting than men do (May-Chahal, 2006) and, relatedly, mother blame is alive and well (Moulding et al., 2015; Moulding, 2016). The research reported on in this article examines women’s narratives of CEA by mothers with the aim of extending feminist understandings of how gender discourses, practices, and power relations constitute this experience.

Method

This article reports on the findings from two research studies. The first study was concerned with how women describe the development of an eating disorder in their lives, although many of the women also struggled with other mental health problems. CEA emerged as a significant theme in women’s explanations, and this in part led to the second study, which focused more specifically on how individuals explain their experiences of CEA and its impact on mental health. This second study included both women and men, although only the analysis of the women’s narratives is included here: analysis of the men’s narratives appears in a second paper. The overarching research question guiding the analysis of data from both studies asked how women describe CEA and its impact on their mental health and well-being. Participants were invited into the studies through advertisements in newspapers and on campus and were involved in 1-hr interviews that were recorded and fully transcribed. Interview questions for the first study asked women about the contexts in which their eating disorder emerged and how they understood the relationship between these and later mental health problems, with many women offering up experiences of childhood physical, sexual, and emotional abuse: I have included here the five who focused on emotional abuse. Interview questions for the second study involved asking individuals to explain their experiences of CEA and how they understood its impact on later mental health and well-being. Ethics committee approval was sought and obtained from the University of South Australia’s Human Research Ethics Committee.

Together, the two studies comprised a sample of 13 women. Seven of the women were under 25 years of age, and the other six women were aged between 40 and 55 years. The sample was reasonably diverse in terms of class backgrounds, with seven women identifying working class backgrounds, five middle-class backgrounds, and one an upper class background. In most of the women’s families, mothers took all or most of the responsibility for the domestic realm and the care of children, while fathers were the primary or sole breadwinners. Most of the participants were undertaking tertiary studies at the time of the interviews because some of the recruitment was on campus. Cultural backgrounds included some diversity, with most participants Anglo-Celtic and one reporting an Indigenous Australian background. In addition, there was one participant each from Middle Eastern, eastern European, and southern European backgrounds. Other than the participant from the Middle East, who had migrated within the last 15 years, all were second or third generation Australian. Six participants described families where one parent had a mental illness (all mothers) and three participants described highly conflicted relationships between the parents, although none of these were named as domestic violence. The research reported on in this article is, therefore, distinctive for its focus on the gendered dimensions of CEA outside the context of domestic violence. Two of the mothers who were reported as having serious mental illnesses were also thought to have been sexually abused by their fathers as children. Seven of the participants disclosed childhood sexual abuse in addition to emotional abuse while five reported physical abuse. In three cases, participants described both their fathers and mothers as emotionally abusive; in four cases, fathers were described as the abusers; and in five cases, mothers were described as abusive. Two women reported physical and emotional abuse from older brothers, and another two reported sexual abuse from older brothers. One woman also described her grandfather perpetrating sexual abuse in addition to emotional abuse from both her parents. Many women had consequently experienced multiple forms of abuse, especially CSA and CEA. It is not possible to tease out the singular effects of CEA when multiple forms of abuse have been experienced. However, the following analysis nonetheless provides insights into the gender discourses, practices, and power relations constituting CEA and the connections with those constituting other forms of gendered violence and abuse.

Both research studies were framed by a poststructural feminist perspective, which emphasizes the constructive use of language and the ways in which gender inequalities are reproduced in the structuring of explanations of women through historical, social, and political discourse (McNay, 1992, 2004; Weedon, 1997). As argued by Weedon (1997), language is “the place where actual and possible forms of social organization and their likely social and political consequences are defined and contested…it is also the place where our sense of ourselves, our subjectivity, is constructed” (p. 21). Subjectivity is produced in a range of discursive practices which are very often highly gendered, and the meanings of these can be understood as sites of struggle over power (Weedon, 1997). The studies were interested in the discourses women draw on to explain their experiences of CEA and the implications for subjectivities and subject positions. I also drew on the performative idea of “doing gender,” or gender practice, where gender is understood to be interactional and “a way in which social practice is ordered” (Connell, 2005, pp. 71–72). Lastly, the studies were more broadly framed by McNay’s (2004) concept of situated intersubjectivity, which understands the discursive aspects of identity and everyday intersubjective material power relations as inherently intertwined. This draws attention to the reproduction of gender power relations, and the links to socioeconomic and state structures, in gendered violence and abuse. Thus, while the studies were concerned with discourse, subjectivities, and gender practices, they were also based on the understanding that social discourses and practices reflect and reproduce material gender power relations.

Discourse analysis was used to explore how women’s accounts drew on particular discourses to explain CEA and its impact on their subjectivities. The first step in data analysis involved thematic coding of the data (Sarantakos, 2012). This involved initial axial coding of the main themes in each data set, followed by more detailed selective coding of specific subthemes and the relationships between them (Sarantakos, 2012). Discourse analysis was used to explore the structuring effects of language within individual explanations of experiences and the subject positions available within these. The method of discourse analysis used here was most closely associated with the Foucauldian-informed approach of Parker (1992, 2004), which includes particular attention to the way language mirrors and reproduces power relations. While there is no one definitive approach to discourse analysis, the different approaches share “a concern with the ways language produces and constrains meaning, where meaning does not, or does not only, reside within the individual’s head, where social conditions give rise to the forms of talk available” (Burman & Parker, 1993, p. 3). Thus, “meanings are multiple and shifting, rather than unitary and fixed” (Burman & Parker, 1993, p. 3). This approach also recognizes that discourses position subjects in particular ways, which have particular implications for power relations (Parker, 1992). The specific steps undertaken in the discursive analysis of the interviews were guided by the criteria and associated steps for discourse analysis outlined by Parker (1992, 2004).

The following analysis focuses primarily on the gendered dimensions of women’s narratives of CEA. The narratives also included other elements not particularly relevant to gender, such as presenting CEA as a function of parental mental illness or alcoholism. It is fair to say, although, that the portrayal of CEA by the women was primarily gendered in its orientation, and I have purposefully and selectively focused on these aspects to gain insight into the social construction of gendered subjectivities through abuse. The participants also identified a host of mental health problems which they traced to their experiences of CEA including anxiety, particularly PTSD and panic; depression; bipolar disorder; dissociative identity disorder in one of the women who was also severely sexually abused; and eating disorders. My concern was not to establish a causal relationship between abuse and mental illness, though: Rather it was to explore the discourses women draw on to make sense of their experiences of abuse and mental illness and their implications for subjectivities. Nonetheless, in line with research evidence about the effects of abuse on mental health (e.g., Messman-Moore & Garrigus, 2007), the most serious mental health problems of severe PTSD, dissociative identity disorder, and severe eating disorders all involved both emotional abuse and extensive intrafamilial sexual abuse that was usually denied within the family.

Results

Initial thematic analysis revealed three main overarching themes in the women’s narratives of CEA. In the first theme, CEA is presented as concerned with the surveillance and control of female bodies and sexualities. In the second, CEA is portrayed as focused on the imposition of domestic and caring responsibilities. In the third theme, CEA is situated in contradictory discourses about what is expected of contemporary women and girls. In the following analysis, I show how CEA can be understood as a gender practice that is constituted by a host of gender discourses about the female body and social expectations of women and girls. Extracts from the interviews are presented to demonstrate each of these themes. Pseudonyms have been used to protect participant identities.

Discussion

In contrast to the gender neutral approach of much of the existing research into CEA, the above analysis demonstrates how CEA can be constituted through gender practices that are embedded in a host of gendered discourses about the female body and expectations of women and girls. Hence, CEA was represented in many narratives as a gender practice concerned with pressuring girls and women to “do femininity” in certain ways (Connell, 2005), particularly the performance of a controlled body, passive sexuality, and the care of others. Gender practices of surveillance and control were implicitly based on a series of traditional, long-standing discourses about women and girls that construct the female body as a sexualized object that must be controlled and contained, including the idea that women’s bodies and behavior incite sexual assault. Other practices of CEA were embedded in assumptions that women should be selfless and carry responsibility for the domestic realm and care of children and the sick. CEA was constructed in many accounts, then, as a form of everyday sexism concerned with enforcing a traditional femininity that is sexually constrained, decorative, selfless, and primarily concerned with service to others. Lurking behind this is the specter of its opposite—a dangerous, out-of-control female sexuality and self-centeredness. Conflicted notions of femininity were consequently in play in these accounts, one “good” and the other “bad” (and usually sexualized), with these binaries embedded in long-standing historical discourses about women and the feminine (see Wirth-Cauchon, 2001). CEA was also framed in women’s narratives by broader contemporary contradictions about gender where women are simultaneously expected to be persons, with all the rights and entitlements to autonomy, independence, and self-determination that go with western humanist conceptions of individuality (which are actually coded male) and nonpersons in the service of others (Gonick, 2004). These contradictions underpinned the women’s experiences of no win femininities, that is, a sense of being “damned if you do and damned if you don’t.” While postfeminism would challenge the idea that modern femininities any longer fall into neat gendered dichotomies such as these, “this does not imply that the processes organizing gender difference are no longer in operation” (Genz, 2009, p. 2). CEA, as it was constructed in these narratives, is arguably one such process that many women and girls continue to encounter in their day-to-day lives.

The findings from this research extend feminist theorizations of gendered violence and abuse in four important ways. First, they demonstrate how different forms of violence against women are constituted through many of the same gender discourses, practices, and power relations. A number of the gender discourses I have identified as constituting practices of CEA echo those identified by feminist research into childhood sexual abuse, domestic violence, and rape and sexual assault. Discourses and practices that blame and hold women responsible for others’ feelings and behavior, discourses that position women as servicers of others’ needs, and those positioning women as property and as sexualized objects whose bodies are not their own are common to women’s experiences of sexual abuse (Reavey & Warner, 2003; Warner, 2009), domestic violence (Wendt & Zannettino, 2015), rape and sexual assault (Gavey, 2005), and CEA (Moulding, 2016). It is likely that where women experience multiple forms of abuse, gendered discourses, and practices work to reinforce each other and amplify the effects in complex and compounding ways.

Second, the findings show how the discourses and practices constituting CEA are intertwined with structural gender inequalities (McNay, 2004) founded on symbiotic systems of male dominance and privilege at macro- and microlevels, including within families (Hunnicutt, 2009). Most of the women described growing up in families where their mothers took all or most of the responsibility for children and the home. Fathers were usually the main or sole breadwinners and were often uninvolved in care or absent. Fathers also drove much of the abuse through their positions of power in the family (and wider society), with their abuse particularly concerned with imposing a traditional femininity on their daughters. As indicated in the analysis, some of the women portrayed fathers (and sometimes brothers) appraising their weight and sexualities through the male gaze and criticizing their refusals to take on traditional roles through the use of highly pejorative, disparaging, and profoundly gendered terms of abuse such as selfish bitch, “slut,” “princess,” and calling the women fat. Abuse by mothers took place within these unequal gender power relations in the family and was often portrayed as secondary to the abuse perpetrated by fathers. It was also depicted as less brutal, as bound up with the gendered burden of domestic responsibilities, and as occurring alongside nurturing practices. Abuse by mothers was also presented in the context of mental illness related to their own experiences of CSA, pointing to the historical and complex nature of women’s subjection to abusive gender discourses, practices, and power relations across the life course. However, mothers were nonetheless at times held individually responsible for CEA. Mothers are positioned in society as almost entirely responsible for the well-being and care of their children (Gross, 1998), even in domestic violence where abuse is perpetrated by the male partner (Weisz & Wiersma, 2011). The use of mother-blame discourses in the narratives of CEA echoes mother blame in other types of gendered violence, pointing to the need to situate all abuse within unequal gender power relations and the gender discourses and practices that maintain them.

Third, the analysis demonstrates how the structural gender power relations framing abuse are fluid and shifting over time rather than fixed and unchanging (Hunnicutt, 2009). Hence, some of the narratives captured shifts in gender power relations over the last part of the 20th century in Western societies, with women’s experiences of CEA coming to reflect growing contradictions between traditional discourses about women and more contemporary ones. Related to this, the analysis showed how many women actively resisted pressures to do femininity in ways they saw as oppressive and self-denying, laying bare the everyday nature of sexual politics and the ways that “gender relations are continually being contested” (Franzway, 2016, p. 19), including at microlevels of interaction within families. Stark (2007) theorizes that some men’s efforts to enforce a servile, submissive femininity on female partners through coercive control in domestic violence represent a reaction to shifts in contemporary gender power relations and the position of women in heterosexual relationships. Those elements of CEA concerned with imposing a traditional femininity on daughters may also reflect a (not necessarily conscious) effort at some level to maintain a gender order within families based on male dominance and female subordination in the context of shifting gender discourses and power relations. I am not suggesting that coercive control of female partners and CEA perpetrated against daughters are one and the same phenomenon, but that they are framed by the same shifts in gender power relations in Western societies over the past few decades.

Lastly, the findings show that while many women resisted the pressure to adopt traditional femininities through CEA, many were nonetheless left with the impression that there was something fundamentally wrong with them as a result of CEA. Many women described powerful feelings of worthlessness, anxiety, guilt, confusion, and shame in response to abuse, often for many years afterward. As noted, it is impossible to tease out the singular effects of CEA from other forms of abuse experienced by the women. However, the effects are likely to reinforce and compound each other when there are similarities between the gender discourses and practices that constitute them. This may help to explain why experiencing multiple forms of abuse is related to more severe psychological and emotional distress for women (O’Dougherty Wright et al., 2009). Because this research is qualitative and the sample small, it cannot make claims about the links between CEA and mental illness. However, it was certainly the case that in line with aspects of Harper and Arias’s (2004) findings, many of the women described struggling with the so-called internalizing problems of anxiety, depression, eating disorders, self-harm, and dissociation. There is evidence that individuals who attribute maltreatment to factors external to themselves do better than those who attribute abuse to internal factors, such as rejection of themselves as bad people (Doyle, 2001). What this research shows is how processes of attribution and internalization in CEA can be constituted through gendered discourses, practices, and power relations rather “biological” gender differences as is implied in much of the psychological research.

The findings point to the importance of social workers and other practitioners working with abused women through a feminist lens that situates abuse-related emotional distress in its gendered social context. Social work has historically taken a leading role in the development of feminist-informed therapeutic approaches in the area of gendered violence. An example is the use of narrative therapy with abused women, with its poststructural approach to the social construction of subjectivities in language and attention to the gender discourses and power relations framing these experiences (White, 2004). More recently, there has been growing interest in the potential of compassion focused therapy (CFT) as an approach for working with abused individuals. Quantitative research has shown that large numbers of abused women report high levels of shame and self-criticism and low levels of self-compassion (Tanaka et al., 2011; Yarnell et al., 2015). CFT specifically aims to increase self-compassion and reduce shame (Gale, Gilbert, Read, & Goss, 2014; Kelly, Carter, & Borairi, 2014), its strength lying in its focus on emotional distress, and the need to develop self-caring practices. As with other helping professions, there is also growing interest in trauma-informed care within social work. However, both CFT and trauma-informed care emerged from within psychology and lack a critical social work perspective on the social construction of self in the context of gender discourses, practices, and power relations. In contrast, Tseris (2013) argues that social workers can draw on trauma theory in ways that stay true to feminist principles by incorporating a postmodern uncertainty about psychological “truths” about “trauma,” a strengths-based approach, helping women work through negative emotions and supporting women in finding new ways of living after abuse. There is arguably further scope for extending and refining social work practice with clients in the area of gendered violence with some of these more recent practice developments in mind. This should be guided by feminist understandings of gendered violence that acknowledge the gendered basis of all forms of abuse, not just sexual abuse; a partnership approach that challenges the gendered discourses and unequal power relations constituting clients’ experiences of abuse and related emotional distress; the challenging of pathologizing psychomedical discourses that locate psychological “disorder” within the individual; and the promotion of self-caring practices to help ameliorate shame and self-criticism. Appropriate counseling and support services also need to be accessible to individuals who are struggling with histories of CEA. Social workers who work with children also need to be attuned to damaging effects of CEA in addition to the more well-known forms of child abuse and work toward protecting and supporting children who find themselves in these circumstances. Lastly, social work is concerned with social change beyond the individual, so energy must be also directed toward the prevention of gendered violence and child abuse through social policies and programs that redress the underlying gender inequalities that perpetuate all of its diverse but interconnected forms.

This research has purposely centered gender as the key construct under investigation. While the analysis included some attention to how gender intersects with race and class in women’s experiences of CEA, as the first study to examine the gendered dimensions of this form of abuse, this was not its main focus. Nonetheless, a limitation of the study was that it did not fully attend to how race and class intersect with gender in CEA. Future research could examine and compare women’s experiences of CEA across a diversity of cultural and class backgrounds. Another limitation was that the article focuses exclusively on women: a paper on men’s experiences of CEA and how they contrast with women’s is forthcoming.

Conclusion

This article has shown how CEA can be understood as a gender practice that pressures girls and women to do femininity in traditional ways but also reproduces the contradictions between autonomous personhood and selflessness that distinguish contemporary Western femininities more generally. It is important for social workers to be aware of how these discourses and practices constitute CEA and the emotional distress women report as a result of it. There is arguably a need for therapeutic and preventive interventions that are gender aware and support women in their resistance to damaging gender discourses, practices, and power relations. These must target not only individual-level distress, though, but also the social, cultural, and economic gender equalities at macro- and microlevels that enable problematic gender discourses and practices to flourish and reproduce in the everyday.