سوء استفاده جنسی و ناتوانی ذهنی: آگاهی برای یک مداخله بهتر

Many intellectual disabled persons, victims of sexual violence–more frequently than in the valid population–cannot still be taken seriously and, consequently benefit from the necessary specific care. Their cognitive and mnesic difficulties of chronological benchmarks, in space, comprehension or (verbal or non-verbal) elocution are sources for mistakes, insufficiencies and contradictions within their own answers are often the cause for doubting about their credibility, and disability as an aggravating circumstance concerning law matters may backfire on these victims. The recent neurobiological works on psychological traumas with severe consequences on mental health will be at first introduced. They involve specific psychic disorders, post-traumatic stress disorder with syndromes of revivification and avoidance and/or dissociative symptoms, and physical health–neurovegetative and hyperactivity–disorders. Secondly, we deal with situations of two young persons who were victims of sexual abuse and had developed a post-traumatic pathology with traumatic memory that was not diagnosed as such in their specialised institution and in the psychiatric hospital. Families had to find the specific treatment allowing to stop the psychic-medicine escalation and the directing toward hosting structures. Prior to their treatment is the family and social attitude toward violence to disabled persons.

It is, unfortunately, an observation that young intellectually-impaired people who are victims of sexual abuse cannot be taken seriously and consequently benefit from compulsory specific treatment. The commission of inquiry on “abuse toward disabled people in institutions, social and healthcare services and (on) means to prevent it” (25 000 in France) observed “a limited interest for abuse of disabled people from many (state) institutions”: either social or the health-insurance and/or justice department concerning protection of vulnerable adults (report no339 presented to the Senate on the 5th June 2003, page 61). “The commission of inquiry during its investigation not only observed the lack of reliable statistics concerning acts of abuse on disabled persons but also the embryonic number of statistics themselves… In 2002, 209 cases of abuse recorded in social and healthcare institutions have been transmitted to the General Director for Social Affairs… The most frequently-recorded cases of violence are cases of sexual abuse representing 48 %, i.e. 104 cases, including 30 rapes… An administrative inquiry is conducted in over half the cases–56.6 %–and the public prosecutor is referred to in 84 % of the cases” (page 69). “Training to the issue of abuse is also recent and embryonic concerning not only medical and paramedical professions but also managers of institutions and social and healthcare services” (page 63), developed after Law 2002–2 (renovating social and healthcare action in order to guarantee rights and individual freedom for the users). The aim of this article is to have an interest for behaviours linked to traumatic memory after sexual abuse among behaviours that can be observed in teenagers and young adults with intellectual impairment ( Blanc and Juilhard, 2003).

People with intellectual impairment can reveal they were victims of abuse that was there sexual and that they were the target. But the diagnosis can be made only if the professionals have some open investigation when facing recent behaviour disorders in these persons or older disorders but unexplained by the disability. The professionals have to have a prior knowledge of post-traumatic and post-sexual abuse specific symptomatology. And, considering that such traumas among the disabled are frequent, an automatic search can be started. Treatment of the consequences of violence is possible among the intellectually-impaired people but it must be done as early as possible. It is required that acts of violence toward them is recognized; if not, the offered follow-up will have no real therapeutic effect or–worse–will amplify the problem and worsen it. The specialized follow-up requires to know, on one hand, the psychic mechanisms taking part and, on the other hand, the means of analysis and expression of each disabled person. Prior to treatment is, hence, the social and family attitude toward abuse, experienced by the disabled. Why are the suffering and experience of these persons so little considered? Judiciary responsibility is at stake but also social representation, so do we have to think that, in the eyes of “normal” people, it is not possible the disabled person may attract (instead of being rejected) and hence be a victim of sexual abuse. There is also an issue of Public Health as the consequences of abuse–not taken into account as such–have some cost for the dependant victims, for their families and for society.