In January 2021 Camille Kouchner – daughter of the charismatic founder of Medecins sans Frontiers (Doctors without Borders) Bernard Kouchner who later went on to became Minister for Health – published her book La Familia Grande. In it she told the story of how her brother was victim to incest by their step-father as they grew up in the comfortable surroundings of the large family holiday home in the south of France. She describes the process of individual and collective denial within her family including her own personal struggle between knowing and not knowing for many years. The publication sparked off a huge public outcry, sent shock waves through the upper echelons of French society and resulted in an Presidential announcement two weeks later setting up a public commission to review the situation of incest and child abuse in France.
The CIIVISE commission worked for three years collecting and annotating statements from nearly 30,000 victims of incest and childhood sexual abuse in an attempt to measure the extent and the nature of this deeply denied social phenomena. For many of the victims it was the first time where they divulged their experience of childhood abuse in a protected public forum. The commission delivered its final report and recommendations in November 2023.
Although numbers can never reflect the true nature of suffering they can give a clearer idea of the extent of this social phenomena.
The commission estimates 160,000 children are victim of rape and sexual abuse every year in France. That translates into a child being abused every three minutes. Of these incidents of abuse only 19% are officially declared to the authorities and only 3% of authors of childhood abuse and only 1% of authors of incest are finally condemned.
In cases where abuse has been officially declared only 25% of victims receive any form of professional care and support. This lack of support may be due to a tendency to minimise the effects of abuse on children or to a lack of confidence in those institutions which are designated to provide such care. The overwhelming majority of victims of childhood abuse receive no support whatsoever.
The annual cost of the impunity of aggressors and the lack of social support for victims has been estimated to be 9,7 billion euros in public spending. This is a conservative estimate. The long-term negative health effects of childhood sexual abuse on victims represents 69.2% of this figure (6,68 billion euros per year). According to the CIIVISE commission only the development of specialised treatment for psychotrauma (simple, complex and developmental) can help to reduce this cost.
Supporting the shoulder
She had endured years of childhood sexual abuse. But somehow she had survived, putting it all aside and getting on with her life. Unwittingly she became a workaholic and along the way developed an array of bewildering somatic illnesses while she secretly fought off suicidal thoughts. Despite an incredible capacity to resist she finally worked herself into the ground. Then a bout of well-timed therapy punched a hole in her self-forgetting and memories of the abuse streamed back up from the past.
She came to work with me because she sensed her body needed support her previous therapist wasn’t capable of providing. After several months of working together, exploring and adjusting the limits of the therapeutic relationship, I finally proposed to work directly on the body.
An area where strong memories of abuse was located was in her shoulder. She had worked regularly with other manual therapists but the shoulder remained full of tension and she had several displaced vertebrae in the neck.
I invited her to lie down on a mattress and covered her with a thick blanket to help her body feel safer and less exposed. At this point we had developed a good working relationship and she was aware this work could be triggering for her. We convened that if she wanted me to stop at any time to give me a signal or if at anytime I felt it was too much I would stop myself.
I placed my two hands underneath the shoulder to make a supportive, non-invasive contact. Then I synchronised it with the breathing to invite the shoulder to release its weight a little more into my hands. She immediately closed her eyes, turned her head off to one side and began groaning in a particular way. She had already expressed this sound in several of our previous session while sitting down. So it didn’t come as a complete surprise. But I was surprised nonetheless. Her throat tightened and it sounded like she was having difficulty breathing, as if someone was choking her. I became a little concerned. But she made no sign to stop. I asked if she was ok. She nodded it was.
Inside the shoulder I could feel the different tissue layers shifting and moving, as if they were squirming. I talked to the tissue layers and said it was ok. I was here. I wasn’t going to do anything. I was just here to support them. If they needed to squirm, that was ok too.
At one point the shoulder began to lift out of my hands. My hands followed the movement to support the shoulder in the direction it wanted to go. Then on an outbreath the shoulder released its full weight back into my hands for the first time. I held it there sensing the whole body was now taking a deep pause and on the following inbreath lifted the shoulder gently towards the diaphragm.
In response the groaning sounds deepened. She kept her eyes closed, turning her head from side to side, as she emitted strangled sounds in successive waves. I could hear a deep unspeakable pain. For several minutes the process cycled between waves of sound and moments of stillness. The body was clearly pendulating between a sympathetic and parasympathetic mode as it started to slowly come out of a freeze position. And when it was enough, her body relaxed, her shoulder dropped and she turned her head to look at the ceiling.
When she sat up she reported that when she first closed her eyes she immediately connected to the scene of the childhood abuse. She dried her glistening eyelids. But this time she was less emotionally affected and felt greater distance with the events. To her surprise her shoulder felt more relaxed. It feels much better than after all the recent sessions of physical therapy I’ve had, she said. I wasn’t sure if she was being overly enthusiastic or if it was really true.
At our next session she brightly reported her manual therapist had finally been able to reset the displaced vertebrae in her neck.
