RESEARCH PROPOSAL
RESEARCH TITLE:
A retrospective study on the presence of mental disorders diagnosed on the sexually abused clients referred to the Women and Child Protection Unit at the National Center for Mental Health (NCMH).
RESEARCH OBJECTIVES:
1. To determine the incidence and comorbidity of mental illness found in the sexually abused clients referred at the NCMH from January – December 2001.
METHODOLOGY
A statistical study from representative data gathered from 100 clients with complete court reports referred to the NCMH from January to December 31, 2001.
PROPOSED BY:
M.D.
Medical Office III
DISCUSSION
A total of 100 documented cases of family violence, obtained from the files of the NCMH covering the period from 2001-2002, were analyzed statistically, based on the list of factors that could provide a comprehensive profile of these clients. The following general findings of the study show the extent and the kind of abusive and violent environment the clients were in and the circumstances which have triggered such events to happen.
1. Violence in the family consists of several forms of abuses - physical, verbal, economic, emotional and sexual. Due to their vulnerability in the family structure, it is often the women and the children who are the recipients of such acts of violence. Figure 1 shows a graph of the different forms of abuse. For this study, the most common form of abuse is sexual assault (66%), followed by physical abuse (18%) and then by verbal abuse (10%). There was also an incidence of economic abuse (1%), plus an incidence wherein verbal, physical and economic abuse occurred simultaneously (1%). Other forms of abuse (3%) consisted mostly of varying degrees of emotional abuse with combinations of any of the aforementioned types.
Some of these abuses occur in different combinations. Sexual abuse is often accompanied by physical and verbal abuse .A typical example would be a case of a male neighbor molesting a young girl after which he menaces the girl with pernicious words and promises of retaliation if the victim seeks help. Another would be a case of a young girl being raped by a distant family relative and then being taunted by a series of physical and verbal threats.
Figure 1. Forms of Abuse
2. Victims experience violence repeatedly at varying periods of time (worst case was one victim who was raped every Sundays), in the hands of the same or different household members from brother to father or uncle to a male neighbor (the most frequent abuser) to the stepfather, in-laws, foster parents, siblings and employers (in the case of domestic helpers). The cycle of violence usually starts with one form of violence that leads to another. There have been cases wherein such abuses led to sexual molestation and rape.
Figure 2. Progression of Violence
Figure 2 shows the graph of the progression of violence. Typical progressions are: a) physical abuse to sexual abuse to rape (71%); and b) sexual molestation to rape and economic abuse to physical abuse (15%). There were also cases of verbal abuse that led to physical assault (7%) and verbal abuse that led to physical abuse, sexual molestation and finally, to rape (5%). In some cases, rape was also preceded by verbal abuse and physical assault (2%). Rarely is one abuse exclusive of another.
3. Figure 3 shows the age range of the clients. The average age of the victims is 15.27 years old. The most dominant group, comprising sixty-two percent (62%) of the clients, were between the ages eleven to seventeen. Twenty- two percent (22%) were young adult females, with ages between 18-24 years old. Twelve percent (12%) were of children’s age, between 4-10 years old. The youngest victims were a 5-year old boy and girl, while the oldest was a 48-year old widow.
Figure 4 shows the civil status of the clients, with ninety-nine percent (99%) of the respondents being single. Only one was a widow. On the other hand, figure 5 shows the gender of the clients. Almost all victims were female (95%) and only 5% were male.
Figure 7 shows the educational attainment if the clients. Almost all of the victims have been educated, half of which reached elementary education (58%), 1/3 reaching high school (31%), and 2% of them reaching college. Nine percent (9%) were still of pre-school age and even then, did not still go to school.
Figure 9 shows the employment background of the victims. About 82 % of the victims (8 out of 10) are not gainfully employed, since most of them are minors. The rest, who are of working age, toil in menial types of jobs.
Minors (aged 0-17) comprise an overwhelming 84% of the total victims of abuse. More than half of the cases of domestic violence against children and minors involve some form of sexual abuse. Figure 10 shows the most common abuses against minors. Rape is the most common form of assault against minors (46%). This is followed by sexual molestation (17%), physical abuse (12%), incestual rape (9%) and pregnancy out of wedlock (8%).
Figure 3. Age of Victim (in Years Old)
Figure 4. Civil Status
Figure 5. Gender
Figure 6. Address / Area
Figure 7. Educational Attainment
4. Figure 6 shows that most of the clients came from Quezon City (20%), with Pasig City and Nueva Ecija next (11%) followed by Mandaluyong City (7%). The clients came from as far as San Jose, Occidental Mindoro, Batangas and most of the cities and municipalities in Metro Manila
Figure 8. Person Who Brought Patient to Hospital
5. Figure 8 shows the graph of the persons who brought the patient to the hospital. The mother of the patient was the most common helper (42%), followed by the grandmother (26%), the auntie (13%). Nonrelatives accounted for 19% of the people who helped the patient.
Figure 9. Employment of Victim
Figure 10. Forms of Violence Against Minors
4. Forty-one cases of mental illness were found. Figure 11 shows a graph of the figures. The most common mental illnesses were major depression and mild mental retardation (32%). Both accounted for more than half of the cases. Another common form of mental illness was moderate mental retardation (20%). There were also cases of bipolar affective disorder (10%), severe mental retardation (5%) and schizophrenia (2%).
Figure 11. Presence of Mental Illness
Figure 12. Number of Episodes of Sexual Abuse
5. Figure 12 shows the number of episodes of sexual abuse. The frequency of sexual abuse ranged from once to more than five times. The most common number of episodes of sexual abuse ranged from once (32%) and more than five times (36%). A repeat of the first sexual abuse was also fairly common (27%). More than half of the number of episodes (68%) occurred more than once, showing that the perpetrator has easy access and has more power economically, physically and emotionally than the victim, that’s why the perpetrator can repeatedly abuse the victim.
6. Figure 13 shows the profile of the perpetrator. The most common perpetrator of assaults on women (young and adult) is their male neighbors, who account for 30% of the abuses. The average age of the perpetrator is 32 yrs. old, more than double that of their victims (15 yrs. old).
Figure 14 shows the educational attainment of the perpetrator. Generally, he is more educated than his victim. Only 31% of the victims reached high school as compared to the 45% of the perpetrators. Only two percent (2%) of the victims were able to reach tertiary education compared to the 11% of the perpetrators. One-fourth of the perpetrators finished elementary.
The child molester or abuser is significantly older than his victim. Two out of five men who victimized children and minors are in their 30’s or 40’s. The abuser’s average age is 32 yrs. old, more than twice that of their victims, whose average age is 15 yrs. old.
Figure 15 shows a graph of the abusers of minors. The most frequent abuser of minors is their male neighbors (30%), followed by their uncles (12 %), and their fathers (8%).
Figure 15. Abusers of Minors
7. Figure 16 shows the aggravating circumstances of the abuse. Most child abuses took place at home while the victim is alone (42%). Victims are often easy prey even at their own homes since this is where they usually feel safe. And often, their mothers also have the same mindset. As this study shows, they are often wrong. One-fourth of the victims are usually young, trusting and vulnerable. One half of the cases involve absentee parents, meaning some belong to broken families and the other cases happened while the parents are away or working. This underscores the need for supervised childcare (as most of the perpetrators are male neighbors). Also, the majority of the sexual abuses occurred at night. There were even cases wherein the perpetrator shared rooms with the victim. This shows that the separation of sleeping quarters or rooms and the presence of household members seemed to be no assurance against sexual abuse.
The influence of alcohol or drugs on the abusers is a major exacerbating factor in domestic violence (14%). Aside from that, influences like the presence of pornographic materials, magazines, videotapes, and VCD are potential aggravating factors in child molestation, accounts for a smaller number of cases (1%). Poor quality of family life and relationships is also an aggravating circumstance. There have been cases wherein the spouses fight (3%) and when the husband is unfaithful (1%).
Figure 16 . Aggravating Circumstances
Figure 17 shows the family background of the perpetrator. The graph shows that harsh economic conditions and poor family relationships that prevail in the perpetrator’s family are the major reasons that could have led to the behavior of abuse. The foremost background of the perpetrator is strained family relations (19%), usually that involving the spouse. This is followed by extreme poverty (10%), and a history of abuse (23%) in the perpetrator’s family. This history of abuse can also stem from the fact that twenty-three (23%) percent of the cases involve an abuser who has a history of intoxication before abuse.
Figure 17. Family Background
8. Figure 18 shows the major reasons why the patients don’t report to the authorities. Majority of the victims were minors and often were trusting of their much older perpetrators. Some clients showed resistance, while the much younger ones may not have known that the actions done on them were already a form of abuse. Fear of their own personal safety is the major reason for the victim not reporting their abuse to authorities (37%). Often, they are too young to know that they are already being abused and this ignorance and naivete is a major drawback in resolving these cases, unless an adult intervenes (22%). Another common reason for not reporting is ambivalence or the indecision of the client to report the abuse (20%). Since majority of the clients are minors, they would often not take the initiative to report the abuse without any willing help from their older relatives. Alarmingly, eighteen percent (18%) of the clients feared reporting their ordeal since it would cause embarrassment to their families.
9. Figure 19 shows the effects of the abuse on the clients. It is interesting to note that the effect of the abuse on the children is met by a palliative, instead of something more concrete. This palliative was done by sixty four (64%) of the clients, who decided to move residences, to stay as far away from the perpetrator. Twenty percent (20%) of the clients had to face an even stiffer penalty for reporting their case, and that is ostracism from their own family. These clients are usually the ones who were raped by a family member. Due to the emotional strain caused by the abuse, thirteen percent (13%) of the clients decided to stop schooling for lack of concentration.
This study did not dwell extensively on the true extent of the psychological damage inflicted on the victims and can be the subject of a future follow-up to the study.
Figure 19. Effects of Abuse
Conclusion
Family violence can appear in different forms; physical, verbal, economic, emotional and sexual. However, such incidences are precursors to even more disturbing abuse, which is usually sexual in nature. In this study, such abuse starts with sexual molestation and finally, rape. The majority of the clients in this study are minors, making them easy prey to their much older perpetrators. Their ages ranged from 5–17 years old. These clients often experience violence at varying periods of time, with the perpetrator, being a close relative like their own brother, father, uncle or, their male neighbors. The victims’ average age for this study is only 15 years old, while that for the perpetrator is 32 years old. Most of the patients are female and there were five male patients, all minors. Most of the patients finished either high school or elementary. There were even some who have only started school.
The abuse is often aggravated by the following circumstances: the most common is when the victim is alone. Victims are often easy prey even at their own homes since this is where they usually feel safe. One-fourth of the victims are very young (5-10 years old), trusting and vulnerable. Also, one-half of the cases involve absentee parents, which either means, they belong to broken families or the parents are either away or working. Also, the majority of the sexual abuses occurred at night. Only about a third of the victims experienced abuse only once. The rest had to endure it twice, thrice and even more than five times before the victim had the courage to report to an adult who eventually accompanied the victim to the authorities. There were even cases wherein the perpetrator shared rooms with the victim. The intake of alcohol or the use of drugs is another major aggravating factor, aside from the presence of pornographic materials, magazines, videotapes, and VCD. Other aggravating factors include poor quality of family life and relationships, spousal conflict and when the husband is unfaithful.
For this study, the minors (aged 5-17 years old) comprised an overwhelming majority of the total victims of abuse. More than half of the cases of domestic violence against children and minors involve some form of sexual abuse. The most common abuses against minors are rape, sexual molestation, physical abuse, and to a lesser degree, incestual rape and pregnancy out of wedlock.
Majority of the patients came from the Metro Manila area, but there were cases from as far as San Jose, Occidental Mindoro, Laguna, Batangas and Nueva Ecija. Most of the patients are not of working age yet, but those who are, worked in menial jobs. The victims were minors and often were trusting of their much older perpetrators. Some clients showed resistance, while the much younger ones may not have known that the actions done on them were already a form of abuse. The mother of the victim is the one who usually accompanies the victim to the authorities. The grandmother, the auntie as well as friends and neighbors have also helped the victim.
The perpetrator is usually male, the most common, being the victims’ neighbors. It may also include direct relatives like the father and the uncle. The perpetrator, is generally, more educated than his victim. The child molester or abuser is significantly older than his victim. Two out of five men who victimized children and minors are in their 30’s or 40’s.
Mental illness among the victims is not uncommon. These are often direct results of the abuse. The most common mental illnesses among the victims are major depression and mild mental retardation. Another common form of mental illness was moderate mental retardation. There were also cases of bipolar affective disorder, severe mental retardation and schizophrenia.
The following are the main reasons for not reporting to the authorities: fear of their own personal safety, ignorance and naivete, ambivalence or the indecision, and embarrassment to their respective families. The effects of abuse ranged from ostracism from the immediate family, having to transfer residences to avoid retribution and shame from the neighbors, stopping school and some were even institutionalized.
This study shows a general picture of the profiles of the victims as well as that of the perpetrators.
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