[with Middleton et al] ANZJP, 48 (6) 2014, pp.581-583.


It is useful to reflect on the nature of this silence, the mechanisms of which are age-old. Generally speaking, the more hierarchical and male dominated the society, the fewer the rights of women and children and the less interest in holding accountable those who exploit and abuse them. From the late nineteenth century, attempts have been made to shine light on outwardly respectable individuals and institutions which grievously abuse children and aggressively silence those who try to speak out. Along with other groups, psychiatry has accommodated society’s need to maintain silence…. A history of child sexual abuse may be afforded little etiological significance in the patient evaluated for chronic depression, substance abuse, somatoform complaints, ‘borderline’ tendencies, or potentially psychotic symptoms.