Symmetry in Sexology

Another reason why a man’s scent is so important comes from the unusual discovery that body symmetry has sexual allure.

Symmetry, in short, is a sign of good health—an indication that a person carries a low mutation load and has experienced few environmental injuries, or at least possesses the capacity to sustain environmental injuries without their leaving much of a mark.

Scent also gives women cues about a partner’s immune system and body symmetry, and pheromones can unconsciously shape how women become sexually attracted and aroused.

Why women find some men’s voices more attractive than others. The first involves bilateral body symmetry—the health-and-good-genes signal that a person can better withstand the stresses of diseases, injuries, and genetic mutations during development. Body symmetry is more likely to produce deep voices.

(Source: Why Women Have Sex, Understanding Sexual Motivations from Adventure to Revenge)

Sexual Equilibrium

According to the other school, the so-called division of the sexes resulted from suppression of one pole of the androgynous being in order that the vital energies manifesting through it might be diverted to development of the rational faculties.

From this point of view man is still actually androgynous and spiritually complete, but in the material world the feminine part of man’s nature and the masculine part of woman’s nature are quiescent. Through spiritual unfoldment and knowledge imparted by the Mysteries, however, the latent element in each nature is gradually brought into activity and ultimately the human being thus regains sexual equilibrium.

By this theory woman is elevated from the position of being man’s errant part to one of complete equality. From this point of view, marriage is regarded as a companionship in which two complete individualities manifesting opposite polarities are brought into association that each may thereby awaken the qualities latent in the other and thus assist in the attainment of individual completeness.

The first theory may be said to regard marriage as an end; the second as a means to an end. The deeper schools of philosophy have leaned toward the latter as more adequately acknowledging the infinite potentialities of divine completeness in both aspects of creation.

(Source: The Secret Teachings of All Ages_An Encyclopedic Outline of Masonic, Hermetic, Qabbalistic, & Rosicrucian Symbolical Philosophy by Manly P. Hall)

The Human Body in Symbolism_The human is a microcosm of the universe

The Human Body in Symbolism

– Highlight Loc. 4504-4733

The oldest, the most profound, the most universal of all symbols is the human body. The Greeks, Persians, Egyptians, and Hindus considered a philosophical analysis of man’s triune nature to be an indispensable part of ethical and religious training. The Mysteries of every nation taught that the laws, elements, and powers of the universe were epitomized in the human constitution; that everything which existed outside of man had its analogue within man.

The universe, being immeasurable in its immensity and inconceivable in its profundity, was beyond mortal estimation. Even the gods themselves could comprehend but a part of the inaccessible glory which was their source. When temporarily permeated with divine enthusiasm, man may transcend for a brief moment the limitations of his own personality and behold in part that celestial effulgence in which all creation is bathed. But even in his periods of greatest illumination man is incapable of imprinting upon the substance of his rational soul a perfect image of the multiform expression of celestial activity.

Recognizing the futility of attempting to cope intellectually with that which transcends the comprehension of the rational faculties, the early philosophers turned their attention from the inconceivable Divinity to man himself, within the narrow confines of whose nature they found manifested all the mysteries of the external spheres. As the natural outgrowth of this practice there was fabricated a secret theological system in which God was considered as the Grand Man and, conversely, man as the little god. Continuing this analogy, the universe was regarded as a man and, conversely, man as a miniature universe.

The greater universe was termed the Macrocosm—the Great World or Body—and the Divine Life or spiritual entity controlling its functions was called the Macroprosophus. Man’s body, or the individual human universe, was termed the Microcosm, and the Divine Life or spiritual entity controlling its functions was called the Microprosophus. The pagan Mysteries were primarily concerned with instructing neophytes in the true relationship existing between the Macrocosm and the Microcosm—in other words, between God and man.

Accordingly, the key to these analogies between the organs and functions of the Microcosmic man and those of the Macrocosmic Man constituted the most prized possession of the early initiates.

Source: The Secret Teachings of All Ages_An Encyclopedic Outline of Masonic, Hermetic, Qabbalistic, & Rosicrucian Symbolical Philosophy

There is one vital substance in Nature upon which all things subsist.

There is one vital substance in Nature upon which all things subsist. It is
called archoeus, or vital life force, and is synonymous with the astral
light or spiritual air of the ancients. In regard to this substance, Eliphas
Levi has written: “Light, that creative agent, the vibrations of which are
the movement and life of all things; light, latent in the universal ether,
radiating about absorbing centres, which, being saturated thereby,
project movement and life in their turn, so forming creative currents;
light, astralized in the stars, animalized in animals, humanized in human
beings; light, which vegetates all plants, glistens in metals, produces all
forms of Nature and equilibrates all by the laws of universal sympathy—
this is the light which exhibits the phenomena of magnetism, divined by
Paracelsus, which tinctures the blood, being released from the air as it
is inhaled and discharged by the hermetic bellows of the lungs.” (The
History of Magic.)
Highlight Loc. 6862-69

(Source: The Secret Teachings of All Ages_An Encyclopedic Outline of Masonic, Hermetic, Qabbalistic, & Rosicrucian Symbolical Philosophy)

This light can be replaced by Ki/Chi.

Hippocrates dissociated the healing art from the other sciences of the temple…

Hippocrates, the famous Greek physician, during the fifth century before Christ, dissociated the healing art from the other sciences of the temple and thereby established a precedent for separateness.

One of the consequences is the present widespread crass scientific materialism. The ancients realized the interdependence of the sciences. The moderns do not; and as a result, incomplete systems of learning are attempting to maintain isolated individualism. The obstacles which confront present-day scientific research are largely the result of prejudicial limitations imposed by those who are unwilling to accept that which transcends the concrete perceptions of the five primary human senses.


Source: The Secret Teachings of All Ages_An Encyclopedic Outline of Masonic, Hermetic, Qabbalistic, & Rosicrucian Symbolical Philosophy

Faith is the most important for curing diseases.

The Hermetic Theory Concerning the Causations of Disease

According to the Hermetic philosophers, there were seven primary causes of disease. The first was evil spirits. These were regarded as creatures born of degenerate actions, subsisting on the vital energies of those to whom they attached themselves.

The second cause was a derangement of the spiritual nature and the material nature: these two, failing to coordinate, produced mental and physical subnormality.

The third was an unhealthy or abnormal mental attitude. Melancholia, morbid emotions, excess of feeling, such as passions, lusts, greeds, and hates, affected the mumia, from which they reacted into the physical body, where they resulted in ulcers, tumors, cancers, fevers, and tuberculosis. The ancients viewed the disease germ as a unit of mumia which had been impregnated with the emanations from evil influences which it had contacted. In other words, germs were minute creatures born out of man’s evil thoughts and actions.

The fourth cause of disease was what the Orientals called Karma, that is, the Law of Compensation, which demanded that the individual pay in full for the indiscretions and delinquencies of the past. A physician had to be very careful how he interfered with the workings of this law, lest he thwart the plan of Eternal Justice. The fifth cause was the motion and aspects of the heavenly bodies. The stars did not compel the sickness but rather impelled it. The Hermetists taught that a strong and wise man ruled his stars, but that a negative, weak person was ruled by them. These five causes of disease are all superphysical in nature. They must be estimated by inductive and deductive reasoning and a careful consideration of the life and temperament of the patient.

The sixth cause of disease was a misuse of faculty, organ, or function, such as overstraining a member or overtaxing the nerves. The seventh cause was the presence in the system of foreign substances, impurities, or obstructions. Under this heading must be considered diet, air, sunlight, and the presence of foreign bodies. This list does not include accidental injuries; such do not belong under the heading of disease. Frequently they are methods by which the Law of Karma expresses itself.

According to the Hermetists, disease could be prevented or successfully combated in seven ways. First, by spells and invocations, in which the physician ordered the evil spirit causing the disease to depart from the patient. This procedure was probably based on the Biblical account of the man possessed of devils whom Jesus healed by commanding the devils to leave the man and enter into a herd of swine. Sometimes the evil spirits entered a patient at the bidding of someone desiring to injure him. In these cases the physician commanded the spirits to return to the one who sent them. It is recorded that in some instances the evil spirits departed through the mouth in the form of clouds of smoke; sometimes from the nostrils as flames. It is even averred that the spirits might depart in the form of birds and insects.

The second method of healing was by vibration. The inharmonies of the bodies were neutralized by chanting spells and intoning the sacred names or by playing upon musical instruments and singing. Sometimes articles of various colors were exposed to the sight of the sick, for the ancients recognized, at least in part, the principle of color therapeutics, now in the process of rediscovery.

The third method was with the aid of talismans, charms, and amulets. The ancients believed that the planets controlled the functions of the human body and that by making charms out of different metals they could combat the malignant influences of the various stars. Thus, a person who is anæmic lacks iron. Iron was believed to be under the control of Mars. Therefore, in order to bring the influence of Mars to the sufferer, around his neck was hung a talisman made of iron and bearing upon it certain secret instructions reputed to have the power of invoking the spirit of Mars. If there was too much iron in the system, the patient was subjected to the influence of a talisman composed of the metal corresponding to some planet having an antipathy to Mars. This influence would then offset the Mars energy and thus aid in restoring normality.

The fourth method was by the aid of herbs and simples. While they used metal talismans, the majority of the ancient physicians did not approve of mineral medicine in any form for internal use. Herbs were their favorite remedies. Like the metals, each herb was assigned to one of the planets. Having diagnosed by the stars the sickness and its cause, the doctors then administered the herbal antidote.

The fifth method of healing disease was by prayer. All ancient peoples believed in the compassionate intercession of the Deity for the alleviation of human suffering. Paracelsus said that faith would cure all disease. Few persons, however, possess a sufficient degree of faith.

The sixth method—which was prevention rather than cure—was regulation of the diet and daily habits of life. The individual, by avoiding the things which caused illness, remained well. The ancients believed that health was the normal state of man; disease was the result of man’s disregard of the dictates of Nature.

The seventh method was “practical medicine,” consisting chiefly of bleeding, purging, and similar lines of treatment. These procedures, while useful in moderation, were dangerous in excess. Many a useful citizen has died twenty-five or fifty years before his time as the result of drastic purging or of having all the blood drained out of his body.

Paracelsus used all seven methods of treatment, and even his worst enemies admitted that he accomplished results almost miraculous in character. Near his old estate in Hohenheim, the dew falls very heavily at certain seasons of the year, and Paracelsus discovered that by gathering the dew under certain configurations of the planets he obtained a water possessing marvelous medicinal virtue, for it had absorbed the properties of the heavenly

(Source: The Secret Teachings of All Ages_An Encyclopedic Outline of Masonic, Hermetic, Qabbalistic, & Rosicrucian Symbolical Philosophy)

The Principle of Pung, Hwa & Su (wind, fire and water) on Chapter Three of “The Sepher Yetzirah, the Book of Formation

The Sepher Yetzirah, the Book of Formation,

Chapter Three

4. The three Mothers,in the universe are: air, water, and fire. Heaven was created from the elementary fire (or ether),; the earth, comprising sea and land, from the elementary water,; and the atmospheric air from the elementary air, or spirit,, which establishes the balance among them. Thus were all things produced.

5. The three Mothers,, produce in the year heat, coldness, and the temperate state. Heat was created from fire, coldness from water, and die temperate state from air, which equilibrates them.

6. The three Mothers,, produce in man (male and female) breast, abdomen, and head. The head was formed from the fire,; the abdomen from the water,; and the breast (thorax) from air,, which places them in equilibrium.

7. God let the letter(A) predominate in primordial air, crowned it, combined it with the other two, and sealed the air in the universe, the temperate state in the year, and the breast in man (male and female).

8. He let the letter(M) predominate in primordial water, crowned it, combined it with the other two, and sealed the earth in the universe (including land and sea), coldness in the year, and the abdomen in man (male and female).

9. He let the letter(Sh) predominate in primordial fire, crowned it, combined it with the other two, and sealed heaven in the universe, heat in the year, and the head of man (male and female).

Source: The Secret Teachings of All Ages_An Encyclopedic Outline of Masonic, Hermetic, Qabbalistic, & Rosicrucian Symbolical Philosophy

Coexistence between wildlife and humans at fine spatial scales

Coexistence between wildlife and humans at fine spatial scales

  1. Neil H. Cartera,
  2. Binoj K. Shresthab,
  3. Jhamak B. Karkic,
  4. Narendra Man Babu Pradhand, and
  5. Jianguo Liua,1

+ Author Affiliations

  1. aCenter for Systems Integration and Sustainability, Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI 48824;

  2. bInstitute for Social and Environmental Research—Nepal, Fulbari, Chitwan, Nepal;

  3. cDepartment of National Parks and Wildlife Conservation, Ministry of Forests and Soil Conservation, Government of Nepal, Babarmahal, Kathmandu, Nepal; and

  4. dWorld Wildlife Fund—Nepal Programme, Baluwatar, Kathmandu, Nepal
  1. Edited by Gretchen C. Daily, Stanford University, Stanford, CA, and approved August 3, 2012 (received for review June 21, 2012)


Many wildlife species face imminent extinction because of human impacts, and therefore, a prevailing belief is that some wildlife species, particularly large carnivores and ungulates, cannot coexist with people at fine spatial scales (i.e., cannot regularly use the exact same point locations). This belief provides rationale for various conservation programs, such as resettling human communities outside protected areas. However, quantitative information on the capacity and mechanisms for wildlife to coexist with humans at fine spatial scales is scarce. Such information is vital, because the world is becoming increasingly crowded. Here, we provide empirical information about the capacity and mechanisms for tigers (a globally endangered species) to coexist with humans at fine spatial scales inside and outside Nepal’s Chitwan National Park, a flagship protected area for imperiled wildlife. Information obtained from field cameras in 2010 and 2011 indicated that human presence (i.e., people on foot and vehicles) was ubiquitous and abundant throughout the study site; however, tiger density was also high. Surprisingly, even at a fine spatial scale (i.e., camera locations), tigers spatially overlapped with people on foot and vehicles in both years. However, in both years, tigers offset their temporal activity patterns to be much less active during the day when human activity peaked. In addition to temporal displacement, tiger–human coexistence was likely enhanced by abundant tiger prey and low levels of tiger poaching. Incorporating fine-scale spatial and temporal activity patterns into conservation plans can help address a major global challenge—meeting human needs while sustaining wildlife.


  • Author contributions: N.H.C. and J.L. designed research; N.H.C. and B.K.S. performed research; N.H.C. analyzed data; and N.H.C., B.K.S., J.B.K., N.M.B.P., and J.L. wrote the paper.

  • The authors declare no conflict of interest.

  • This article is a PNAS Direct Submission.

  • This article contains supporting information online at

The Shallows: What the Internet Is Doing to Our Brains

– Highlight Loc. 99-103

McLuhan saw: that in the long run a medium’s content matters less than the medium itself in influencing how we think and act. As our window onto the world, and onto ourselves, a popular medium molds what we see and how we see it—and eventually, if we use it enough, it changes who we are, as individuals and as a society. “The effects of technology do not occur at the level of opinions or concepts,” wrote McLuhan. Rather, they alter “patterns of perception steadily and without any resistance.”3


– Highlight Loc. 150-53

As McLuhan suggested, media aren’t just channels of information. They supply the stuff of thought, but they also shape the process of thought. And what the Net seems to be doing is chipping away my capacity for concentration and contemplation. Whether I’m online or not, my mind now expects to take in information the way the Net distributes it: in a swiftly moving stream of particles.


– Highlight Loc. 161-62

Bruce Friedman, who blogs about the use of computers in medicine, has also described how the Internet is altering his mental habits. “I now have almost totally lost the ability to read and absorb a longish article on the web or in print,”


– Highlight Loc. 211-15

John Battelle, a onetime magazine editor and journalism professor who now runs an online advertising syndicate, has described the intellectual frisson he experiences when skittering across Web pages: “When I am performing bricolage in real time over the course of hours, I am ‘feeling’ my brain light up, I [am] ‘feeling’ like I’m getting smarter.”11 Most of us have experienced similar sensations while online. The feelings are intoxicating—so much so that they can distract us from the Net’s deeper cognitive consequences.


– Highlight Loc. 344-46

“You are right,” Nietzsche replied. “Our writing equipment takes part in the forming of our thoughts.”2


– Highlight Loc. 382-83

“It may be therefore that every action leaves some permanent print upon the nervous tissue.”


– Highlight Loc. 455-57

The brains, Merzenich realizes, have reorganized themselves. The animals’ neural pathways have woven themselves into a new map that corresponds to the new arrangement of nerves in their hands.


– Highlight Loc. 472-75

The brain’s plasticity is not limited to the somatosensory cortex, the area that governs our sense of touch. It’s universal. Virtually all of our neural circuits—whether they’re involved in feeling, seeing, hearing, moving, thinking, learning, perceiving, or remembering—are subject to change. The received wisdom is cast aside.


– Highlight Loc. 479-81

plasticity diminishes as we get older—brains do get stuck in their ways—but it never goes away. Our neurons are always breaking old connections and forming new ones, and brand-new nerve cells are always being created. “The brain,” observes Olds, “has the ability to reprogram itself on the fly, altering the way it functions.”


– Highlight Loc. 491-92


the essential dynamic of neuroplasticity with a saying known as Hebb’s rule: “Cells that fire together wire together.”


– Highlight Loc. 506-7

like Immanuel Kant, we are born with built-in mental “templates” that determine how we perceive and make sense of the world. All our experiences are filtered through these inborn templates.


– Highlight Loc. 524-25

to the ready adaptability of neurons, the senses of hearing and touch can grow sharper to mitigate the effects of the loss of sight.


– Highlight Loc. 527-29

Tests on people who have lost arms or legs in accidents also reveal how extensively the brain can reorganize itself. The areas in the victims’ brains that had registered sensations in their lost limbs are quickly taken over by circuits that register sensations from other parts of their bodies.


– Highlight Loc. 534-35

a result of such experiments, it’s now believed that the sensations of a “phantom limb” felt by amputees are largely the result of neuroplastic changes in the brain.


– Highlight Loc. 556-60

Our brains are constantly changing in response to our experiences and our behavior, reworking their circuitry with “each sensory input, motor act, association, reward signal, action plan, or [shift of] awareness.” Neuroplasticity, argues Pascual-Leone, is one of the most important products of evolution, a trait that enables the nervous system “to escape the restrictions of its own genome and thus adapt to environmental pressures, physiologic changes, and experiences.”


– Highlight Loc. 595-96

transcranial magnetic stimulation, or TMS,


– Highlight Loc. 596-99

He found that the people who had only imagined playing the notes exhibited precisely the same changes in their brains as those who had actually pressed the keys.31 Their brains had changed in response to actions that took place purely in their imagination—in response, that is, to their thoughts.


– Highlight Loc. 624-25

Even very small doses of addictive drugs can dramatically alter the flow of neurotransmitters in a person’s synapses, resulting in long-lasting alterations in brain circuitry and function.


– Highlight Loc. 641-45

in The Parts of Animals, a treatise on anatomy and physiology. Blood rises from the “fiery” region of the chest until it reaches the head, where the brain reduces its temperature “to moderation.” The cooled blood then flows back down through the rest of the body. The process, suggested Aristotle, was akin to that which “occurs in the production of showers. For when vapor steams up from the earth under the influence of heat and is carried into the upper regions, so soon as it reaches the cold air that is above the earth, it condenses again into water owing to the refrigeration, and falls back to the earth as rain.” (suseung hwagang)


– Highlight Loc. 686-88

Vincent Virga, an expert on cartography affiliated with the Library of Congress, has observed that the stages in the development of our mapmaking skills closely parallel the general stages of childhood cognitive development delineated by the twentieth-century Swiss psychologist Jean Piaget.


– Highlight Loc. 702-6

The historical advances in cartography didn’t simply mirror the development of the human mind. They helped propel and guide the very intellectual advances that they documented. The map is a medium that not only stores and transmits information but also embodies a particular mode of seeing and thinking. As mapmaking progressed, the spread of maps also disseminated the mapmaker’s distinctive way of perceiving and making sense of the world. The more frequently and intensively people used maps, the more their minds came to understand reality in the maps’ terms.


– Highlight Loc. 719-21

The first people to demand a more precise measurement of time were Christian monks, whose lives revolved around a rigorous schedule of prayer. In the sixth century, Saint Benedict had ordered his followers to hold seven prayer services at specified times during the day.


– Highlight Loc. 723-25

It was in the monastery that the first mechanical clocks were assembled, their movements governed by the swinging of weights, and it was the bells in the church tower that first sounded the hours by which people would come to parcel out their lives.


– Highlight Loc. 748-50

The mechanical clock changed the way we saw ourselves. And like the map, it changed the way we thought. Once the clock had redefined time as a series of units of equal duration, our minds began to stress the methodical mental work of division and measurement.


– Highlight Loc. 875-77

Reading and writing are unnatural acts, made possible by the purposeful development of the alphabet and many other technologies. Our minds have to be taught how to translate the symbolic characters we see into the language we understand. Reading and writing require schooling and practice, the deliberate shaping of the brain.


– Highlight Loc. 911-13

The Greeks analyzed all the sounds, or phonemes, used in spoken language, and were able to represent them with just twenty-four characters, making their alphabet a comprehensive and efficient system for writing and reading.


– Highlight Loc. 943-45

Unlike the orator Socrates, Plato was a writer, and while we can assume that he shared Socrates’ worry that reading might substitute for remembering, leading to a loss of inner depth, it’s also clear that he recognized the advantages that the written word had over the spoken one.


– Highlight Loc. 972-74

The oral world of our distant ancestors may well have had emotional and intuitive depths that we can no longer appreciate. McLuhan believed that preliterate peoples must have enjoyed a particularly intense “sensuous involvement” with the world. When we learned to read, he argued, we suffered a “considerable detachment from the feelings or emotional involvement that a nonliterate man or society would experience.”


– Highlight Loc. 979-81

Ong, in his influential 1982 study Orality and Literacy, took a similar view. “Oral cultures,” he observed, could “produce powerful and beautiful verbal performances of high artistic and human worth, which are no longer even possible once writing has taken possession of the psyche.”


– Highlight Loc. 1030-35

It’s hard for us to imagine today, but no spaces separated the words in early writing. In the books inked by scribes, words ran together without any break across every line on every page, in what’s now referred to as scriptura continua. The lack of word separation reflected language’s origins in speech. When we talk, we don’t insert pauses between each word—long stretches of syllables flow unbroken from our lips. It would never have crossed the minds of the first writers to put blank spaces between words. They were simply transcribing speech, writing what their ears told them to write. (Today, when young children begin to write, they also run their words together. Like the early scribes, they write what they hear.)


– Highlight Loc. 1037-39

In interpreting the writing in books through the early Middle Ages, readers would not have been able to use word order as a signal of meaning. The rules hadn’t been invented yet.2


– Highlight Loc. 1057-62

By the start of the second millennium, writers had begun to impose rules of word order on their work, fitting words into a predictable, standardized system of syntax. At the same time, beginning in Ireland and England and then spreading throughout the rest of western Europe, scribes started dividing sentences into individual words, separated by spaces. By the thirteenth century, scriptura continua was largely obsolete, for Latin texts as well as those written in the vernacular. Punctuation marks, which further eased the work of the reader, began to become common too. Writing, for the first time, was aimed as much at the eye as the ear.


– Highlight Loc. 1065-66

placing of spaces between words alleviated the cognitive strain involved in deciphering text, making it possible for people to read quickly, silently, and with greater comprehension.


– Highlight Loc. 1078-80

The natural state of the human brain, like that of the brains of most of our relatives in the animal kingdom, is one of distractedness. Our predisposition is to shift our gaze, and hence our attention, from one object to another, to be aware of as much of what’s going on around us as possible.


– Highlight Loc. 1330-31

“Writing and print and the computer,” writes Walter Ong, “are all ways of technologizing the word” and once technologized, the word cannot be de-technologized.41


– Highlight Loc. 1435-37

THE NET DIFFERS from most of the mass media it replaces in an obvious and very important way: it’s bidirectional. We can send messages through the network as well as receive them. That’s made the system all the more useful.


– Highlight Loc. 1487-89

hours.”20 Because of the ubiquity of text on the Net and our phones, we’re almost certainly reading more words today than we did twenty years ago, but we’re devoting much less time to reading words printed on paper.


– Highlight Loc. 1510-13

But the old technologies lose their economic and cultural force. They become progress’s dead ends. It’s the new technologies that govern production and consumption, that guide people’s behavior and shape their perceptions. That’s why the future of knowledge and culture no longer lies in books or newspapers or TV shows or radio programs or records or CDs. It lies in digital files shot through our universal medium at the speed of light.


– Highlight Loc. 1523-26

Research has shown that the cognitive act of reading draws not just on our sense of sight but also on our sense of touch. It’s tactile as well as visual. “All reading,” writes Anne Mangen, a Norwegian literary studies professor, is “multi-sensory.” There’s “a crucial link” between “the sensory-motor experience of the materiality” of a written work and “the cognitive processing of the text content.”


– Highlight Loc. 1826-29

To see how small changes in writers’ assumptions and attitudes can eventually have large effects on what they write, one need only glance at the history of correspondence. A personal letter written in, say, the nineteenth century bears little resemblance to a personal e-mail or text message written today. Our indulgence in the pleasures of informality and immediacy has led to a narrowing of expressiveness and a loss of eloquence.19


– Highlight Loc. 1933-36

concentration.”30 In the choices we have made, consciously or not, about how we use our computers, we have rejected the intellectual tradition of solitary, single-minded concentration, the ethic that the book bestowed on us. We have cast our lot with the juggler.


– Highlight Loc. 1940-42

The deeper I dug into the science of neuroplasticity and the progress of intellectual technology, the clearer it became that the Internet’s import and influence can be judged only when viewed in the fuller context of intellectual history.


– Highlight Loc. 1943-44

What can science tell us about the actual effects that Internet use is having on the way our minds work?


– Highlight Loc. 1945-47

Dozens of studies by psychologists, neurobiologists, educators, and Web designers point to the same conclusion: when we go online, we enter an environment that promotes cursory reading, hurried and distracted thinking, and superficial learning.


– Highlight Loc. 1953-54

With the exception of alphabets and number systems, the Net may well be the single most powerful mind-altering technology that has ever come into general use. At the very least, it’s the most powerful that has come along since the book.


– Highlight Loc. 1985-88

Today’s teenagers typically send or receive a message every few minutes throughout their waking hours. As the psychotherapist Michael Hausauer notes, teens and other young adults have a “terrific interest in knowing what’s going on in the lives of their peers, coupled with a terrific anxiety about being out of the loop.”1 If they stop sending messages, they risk becoming invisible.


– Highlight Loc. 2001-4

Dijksterhuis’s work also shows that our unconscious thought processes don’t engage with a problem until we’ve clearly and consciously defined the problem.3 If we don’t have a particular intellectual goal in mind, Dijksterhuis writes, “unconscious thought does not occur.”


– Highlight Loc. 2015-16

“When culture drives changes in the ways that we engage our brains, it creates DIFFERENT brains,”


– Highlight Loc. 2020

Just as neurons that fire together wire together, neurons that don’t fire together don’t wire together.


– Highlight Loc. 2025-26

GARY SMALL, A professor of psychiatry at UCLA and the director of its Memory and Aging Center,

“The current explosion of digital technology not only is changing the way we live and communicate but is rapidly and profoundly altering our brains,” he says. The daily use of computers, smartphones, search engines, and other such tools “stimulates brain cell alteration and neurotransmitter release, gradually strengthening new neural pathways in our brains while weakening old ones.”7


– Highlight Loc. 2036-37

“the computer-savvy subjects used a specific network in the left front part of the brain, known as the dorsolateral prefrontal cortex, [while] the Internet-naïve subjects showed minimal, if any, activity in this area.”


– Highlight Loc. 2038-39

Clearly, the experienced Net users’ distinctive neural pathways had developed through their Internet use.


– Highlight Loc. 2048-55

Book readers have a lot of activity in regions associated with language, memory, and visual processing, but they don’t display much activity in the prefrontal regions associated with decision making and problem solving. Experienced Net users, by contrast, display extensive activity across all those brain regions when they scan and search Web pages. The good news here is that Web surfing, because it engages so many brain functions, may help keep older people’s minds sharp. Searching and browsing seem to “exercise” the brain in a way similar to solving crossword puzzles, says Small. But the extensive activity in the brains of surfers also points to why deep reading and other acts of sustained concentration become so difficult online. The need to evaluate links and make related navigational choices, while also processing a multiplicity of fleeting sensory stimuli, requires constant mental coordination and decision making, distracting the brain from the work of interpreting text or other information.


– Highlight Loc. 2059-62

In reading online, Maryanne Wolf says, we sacrifice the facility that makes deep reading possible. We revert to being “mere decoders of information.”10 Our ability to make the rich mental connections that form when we read deeply and without distraction remains largely disengaged.


– Highlight Loc. 2067-70  12:45 PM

book reading “understimulates the senses” that makes the activity so intellectually rewarding. By allowing us to filter out distractions, to quiet the problem-solving functions of the frontal lobes, deep reading becomes a form of deep thinking. The mind of the experienced book reader is a calm mind, not a buzzing one. When it comes to the firing of our neurons, it’s a mistake to assume that more is better.


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Our brains, he explains, incorporate two very different kinds of memory: short-term and long-term. We hold our immediate impressions, sensations, and thoughts as short-term memories, which tend to last only a matter of seconds. All the things we’ve learned about the world, whether consciously or unconsciously, are stored as long-term memories, which can remain in our brains for a few days, a few years, or even a lifetime. One particular type of short-term memory, called working memory, plays an instrumental role in the transfer of information into long-term memory and hence in the creation of our personal store of knowledge. Working memory forms, in a very real sense, the contents of our consciousness at any given moment. “We are conscious of what is in working memory and not conscious of anything else,” says Sweller.12 If working memory is the mind’s scratch pad, then long-term memory is its filing system. The contents of our long-term memory lie mainly outside of our consciousness. In order for us to think about something we’ve previously learned or experienced, our brain has to transfer the memory from long-term memory back into working memory. “We are only aware that something was stored in long-term memory when it is brought down into working memory,” explains Sweller.


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brain scientists have come to realize that long-term memory is actually the seat of understanding. It stores not just facts but complex concepts, or “schemas.” By organizing scattered bits of information into patterns of knowledge, schemas give depth and richness to our thinking. “Our intellectual prowess is derived largely from the schemas we have acquired over long periods of time,” says Sweller. “We are able to understand concepts in our areas of expertise because we have schemas associated with those concepts.”15 The depth of our intelligence hinges on our ability to transfer information from working memory to long-term memory and weave it into conceptual schemas. But the passage from working memory to long-term memory also forms the major bottleneck in our brain. Unlike long-term memory, which has a vast capacity, working memory is able to hold only a very small amount of information.


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“The Magical Number Seven, Plus or Minus Two,” Princeton psychologist George Miller observed that working memory could typically hold just seven pieces, or “elements,” of information. Even that is now considered an overstatement. According to Sweller, current evidence suggests that “we can process no more than about two to four elements at any given time with the actual number probably being at the lower [rather] than the higher end of this scale.” Those elements that we are able to hold in working memory will, moreover, quickly vanish “unless we are able to refresh them by rehearsal.”16


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The information flowing into our working memory at any given moment is called our “cognitive load.” When the load exceeds our mind’s ability to store and process the information—when the water overflows the thimble—we’re unable to retain the information or to draw connections with the information already stored in our long-term memory. We can’t translate the new information into schemas. Our ability to learn suffers, and our understanding remains shallow. Because our ability to maintain our attention also depends on our working memory—“we


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Using the Net may, as Gary Small suggests, exercise the brain the way solving crossword puzzles does. But such intensive exercise, when it becomes our primary mode of thought, can impede deep learning and thinking.


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Deciphering hypertext substantially increases readers’ cognitive load and hence weakens their ability to comprehend and retain what they’re reading.


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Even though the World Wide Web has made hypertext commonplace, indeed ubiquitous, research continues to show that people who read linear text comprehend more, remember more, and learn more than those who read text peppered with links.


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The division of attention demanded by multimedia further strains our cognitive abilities, diminishing our learning and weakening our understanding. When it comes to supplying the mind with the stuff of thought, more can be less.


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The multimedia technologies so common to the Web, the researchers concluded, “would seem to limit, rather than enhance, information acquisition.”


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The Net is, by design, an interruption system, a machine geared for dividing attention.


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Psychological research long ago proved what most of us know from experience: frequent interruptions scatter our thoughts, weaken our memory, and make us tense and anxious. The more complex the train of thought we’re involved in, the greater the impairment the distractions cause.30


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We want to be interrupted, because each interruption brings us a valuable piece of information. To turn off these alerts is to risk feeling out of touch, or even socially isolated.


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One of Javal’s colleagues at the University of Paris soon made another discovery: that the pattern of pauses, or “eye fixations,” can vary greatly depending on what’s being read and who’s doing the reading.


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Israeli company named ClickTale, found that in most countries people spend, on average, between nineteen and twenty-seven seconds looking at a page before moving on to the next one, including the time required for the page to load into their browser’s window. German and Canadian surfers spend about twenty seconds on each page, U.S. and U.K. surfers spend about twenty-one seconds, Indians and Australians spend about twenty-four seconds, and the French spend about twenty-five seconds.39 On


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The findings, said Liu, indicate that “the digital environment tends to encourage people to explore many topics extensively, but at a more superficial level,” and that “hyperlinks distract people from reading and thinking deeply.”


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The ability to skim text is every bit as important as the ability to read deeply. What is different, and troubling, is that skimming is becoming our dominant mode of reading. Once a means to an end, a way to identify information for deeper study, scanning is becoming an end in itself—our preferred way of gathering and making sense of information of all sorts.


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What we’re experiencing is, in a metaphorical sense, a reversal of the early trajectory of civilization: we are evolving from being cultivators of personal knowledge to being hunters and gatherers in the electronic data forest.


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Jordan Grafman, head of the cognitive neuroscience unit at the National Institute of Neurological Disorders and Stroke, explains that the constant shifting of our attention when we’re online may make our brains more nimble when it comes to multitasking, but improving our ability to multitask actually hampers our ability to think deeply and creatively.


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“The more you multitask, the less deliberative you become; the less able to think and reason out a problem.”


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Knowledge is of two kinds. We know a subject ourselves, or we know where we can find information upon it.’”55 The Net grants us instant access to a library of information unprecedented in its size and scope, and it makes it easy for us to sort through that library—to find, if not exactly what we were looking for, at least something sufficient for our immediate purposes. What the Net diminishes is Johnson’s primary kind of knowledge: the ability to know, in depth, a subject for ourselves, to construct within our own minds the rich and idiosyncratic set of connections that give rise to a singular intelligence.


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Using a technique called “split A/B testing,” Google continually introduces tiny permutations in the way its sites look and operate, shows different permutations to different sets of users, and then compares how the variations influence the users’ behavior—how long they stay on a page, the way they move their cursor about the screen, what they click on, what they don’t click on, where they go next.


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Google doesn’t believe that the affairs of citizens are best guided by experts. It believes that those affairs are best guided by software algorithms—which is exactly what Taylor would have believed had powerful digital computers been around in his day.


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In Google’s view, information is a kind of commodity, a utilitarian resource that can, and should, be mined and processed with industrial efficiency. The more pieces of information we can “access” and the faster we can distill their gist, the more productive we become as thinkers. Anything that stands in the way of the speedy collection, dissection, and transmission of data is a threat not only to Google’s business but to the new utopia of cognitive efficiency it aims to construct on the Internet.


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Google’s profits are tied directly to the velocity of people’s information intake. The faster we surf across the surface of the Web—the more links we click and pages we view—the more opportunities Google gains to collect information about us and to feed us advertisements.


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Google not only identifies new or revised Web pages much more quickly than it used to—it now checks the most popular sites for updates every few seconds rather than every few days—but for many searches it skews its results to favor newer pages over older ones.


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Google’s business strategy. Nearly everything the company does is aimed at reducing the cost and expanding the scope of Internet use. Google wants information to be free because, as the cost of information falls, we all spend more time looking at computer screens and the company’s profits go up.


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Its ideals and its business interests converge in one overarching goal: to digitize ever more types of information, move the information onto the Web, feed it into its database, run it through its classification and ranking algorithms, and dispense it in what it calls “snippets” to Web surfers, preferably with ads in tow. With each expansion of Google’s ambit, its Taylorist ethic gains a tighter hold on our intellectual lives.


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THE MOST AMBITIOUS of Google’s initiatives—what Marissa Mayer calls its “moon shot”29 —is its effort to digitize all the books ever printed and make their text “discoverable and searchable online.”


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But the inevitability of turning the pages of books into online images should not prevent us from considering the side effects. To make a book discoverable and searchable online is also to dismember it. The cohesion of its text, the linearity of its argument or narrative as it flows through scores of pages, is sacrificed. What that ancient Roman craftsman wove together when he created the first codex is unstitched. The quiet that was “part of the meaning” of the codex is sacrificed as well. Surrounding every page or snippet of text on Google Book Search is a welter of links, tools, tabs, and ads, each eagerly angling for a share of the reader’s fragmented attention.


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Google wants us, it says, to be able to “slice and dice” the contents of the digitized books we discover, to do all the “linking, sharing, and aggregating” that are routine with Web content but that “you can’t easily do with physical books.”


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The great library that Google is rushing to create shouldn’t be confused with the libraries we’ve known up until now. It’s not a library of books. It’s a library of snippets.


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The irony in Google’s effort to bring greater efficiency to reading is that it undermines the very different kind of efficiency that the technology of the book brought to reading—and to our minds—in the first place. By freeing us from the struggle of decoding text, the form that writing came to take on a page of parchment or paper enabled us to become deep readers, to turn our attention, and our brain power, to the interpretation of meaning. With writing on the screen, we’re still able to decode text quickly—we read, if anything, faster than ever—but we’re no longer guided toward a deep, personally constructed understanding of the text’s connotations. Instead, we’re hurried off toward another bit of related information, and then another, and another. The strip-mining of “relevant content” replaces the slow excavation of meaning.


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Today, more information is “available to us than ever before,” writes Levy, “but there is less time to make use of it—and specifically to make use of it with any depth of reflection.”


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Sergey Brin “Certainly if you had all the world’s information directly attached to your brain, or an artificial brain that was smarter than your brain, you’d be better off,” he told a Newsweek reporter in 2004.


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In Google’s world, which is the world we enter when we go online, there’s little place for the pensive stillness of deep reading or the fuzzy indirection of contemplation. Ambiguity is not an opening for insight but a bug to be fixed. The human brain is just an outdated computer that needs a faster processor and a bigger hard drive—and better algorithms to steer the course of its thought.


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It’s also a fallacy to think that the physical brain and the thinking mind exist as separate layers in a precisely engineered “architecture.” The brain and the mind, the neuroplasticity pioneers have shown, are exquisitely intertwined, each shaping the other.


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Socrates was right. As people grew accustomed to writing down their thoughts and reading the thoughts others had written down, they became less dependent on the contents of their own memory.


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Books provided people with a far greater and more diverse supply of facts, opinions, ideas, and stories than had been available before, and both the method and the culture of deep reading encouraged the commitment of printed information to memory.


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The memories were of two kinds: “primary memories,” which evaporated from the mind soon after the event that inspired them, and “secondary memories,” which the brain could hold onto indefinitely.15


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Müller and Pilzecker concluded that it takes an hour or so for memories to become fixed, or “consolidated,” in the brain. Short-term memories don’t become long-term memories immediately, and the process of their consolidation is delicate. Any disruption, whether a jab to the head or a simple distraction, can sweep the nascent memories from the mind.16


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Storing long-term memories requires the synthesis of new proteins. Storing short-term memories does not.


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the more times an experience is repeated, the longer the memory of the experience lasts. Repetition encourages consolidation. When they examined the physiological effects of repetition on individual neurons and synapses, they discovered something amazing. Not only did the concentration of neurotransmitters in synapses change, altering the strength of the existing connections between neurons, but the neurons grew entirely new synaptic terminals. The formation of long-term memories, in other words, involves not only biochemical changes but anatomical ones. That explained, Kandel realized, why memory consolidation requires new proteins. Proteins play an essential role in producing structural changes in cells.


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The fact that, even after a memory is forgotten, the number of synapses remains a bit higher than it had been originally helps explain why it’s easier to learn something a second time.


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“Short-term memory produces a change in the function of the synapse, strengthening or weakening preexisting connections; long-term memory requires anatomical changes.”


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“The fact that a gene must be switched on to form long-term memory shows clearly that genes are not simply determinants of behavior but are also responsive to environmental stimulation, such as learning.”


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Molaison’s experience, meticulously documented by the English psychologist Brenda Milner, suggested that the hippocampus is essential to the consolidation of new explicit memories but that after a time many of those memories come to exist independently of the hippocampus.


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The hippocampus seems to act as something like an orchestra conductor in directing the symphony of our conscious memory. Beyond its involvement in fixing particular memories in the cortex, it is thought to play an important role in weaving together the various contemporaneous memories—visual, spatial, auditory, tactile, emotional—that are stored separately in the brain but that coalesce to form a single, seamless recollection of an event.


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The Web has a very different effect. It places more pressure on our working memory, not only diverting resources from our higher reasoning faculties but obstructing the consolidation of long-term memories and the development of schemas. The calculator, a powerful but highly specialized tool, turned out to be an aid to memory. The Web is a technology of forgetfulness.


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The influx of competing messages that we receive whenever we go online not only overloads our working memory; it makes it much harder for our frontal lobes to concentrate our attention on any one thing. The process of memory consolidation can’t even get started. And, thanks once again to the plasticity of our neuronal pathways, the more we use the Web, the more we train our brain to be distracted—to process information very quickly and very efficiently but without sustained attention.


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Our brains become adept at forgetting, inept at remembering.


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Developed by the psychologist Carl Rogers in the 1940s, Rogerian therapists pretended, in their conversations with patients, to have no understanding of the world. For the most part, they simply parroted their patients’ statements back to them in the form of banal, open-ended questions or comments. Knowing that the naïveté was a pose, the patients were free to attribute to their therapists “all sorts of background knowledge, insights and reasoning ability.”


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Eleanor Maguire, the neuroscientist who led the study of the brains of London taxi drivers, worries that satellite navigation could have “a big effect” on cabbies’ neurons. “We very much hope they don’t start using it,” she says, speaking on behalf of her team of researchers. “We believe [the hippocampal] area of the brain increased in grey matter volume because of the huge amount of data [the drivers] have to memorize. If they all start using GPS, that knowledge base will be less and possibly affect the brain changes we are seeing.”23 The cabbies would be freed from the hard work of learning the city’s roads, but they would also lose the distinctive mental benefits of that training. Their brains would become less interesting.


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There’s another, even deeper reason why our nervous systems are so quick to “merge” with our computers. Evolution has imbued our brains with a powerful social instinct, which, as Jason Mitchell, the head of Harvard’s Social Cognition and Affective Neuroscience Laboratory, says, entails “a set of processes for inferring what those around us are thinking and feeling.”


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Recent neuroimaging studies indicate that three highly active brain regions—one in the prefrontal cortex, one in the parietal cortex, and one at the intersection of the parietal and temporal cortices—are “specifically dedicated to the task of understanding the goings-on of other people’s minds.”


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The “chronic overactivity of those brain regions implicated in social thought” can, writes Mitchell, lead us to perceive minds where no minds exist, even in “inanimate objects.”


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While this cybernetic blurring of mind and machine may allow us to carry out certain cognitive tasks far more efficiently, it poses a threat to our integrity as human beings.


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The findings indicated, as van Nimwegen reported, that those using the unhelpful software were better able to plan ahead and plot strategy, while those using the helpful software tended to rely on simple trial and error.


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The more that people depended on explicit guidance from software programs, the less engaged they were in the task and the less they ended up learning. The findings indicate, van Nimwegen concluded, that as we “externalize” problem solving and other cognitive chores to our computers, we reduce our brain’s ability “to build stable knowledge structures”—schemas, in other words—that can later “be applied in new situations.”29 A polemicist might put it more pointedly: The brighter the software, the dimmer the user.


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As more journals moved online, scholars actually cited fewer articles than they had before. And as old issues of printed journals were digitized and uploaded to the Web, scholars cited more recent articles with increasing frequency. A broadening of available information led, as Evans described it, to a “narrowing of science and scholarship.”


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“simple and brief interactions with nature can produce marked increases in cognitive control.” Spending time in the natural world seems to be of “vital importance” to “effective cognitive functioning.”34


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One of the greatest dangers we face as we automate the work of our minds, as we cede control over the flow of our thoughts and memories to a powerful electronic system, is the one that informs the fears of both the scientist Joseph Weizenbaum and the artist Richard Foreman: a slow erosion of our humanness and our humanity.



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Instantaneously—the more sophisticated mental process of empathizing with psychological suffering unfolds much more slowly.


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The experiment, say the scholars, indicates that the more distracted we become, the less able we are to experience the subtlest, most distinctively human forms of empathy, compassion, and other emotions. “For


Healing Trauma_A Professional Guide

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The Impact of Event Scale (IES; Horowitz 1976) was widely used for exploring the psychological impact of a variety of traumas.


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posttraumatic stress disorder (PTSD)


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Posttraumatic Stress Disorder Checklist (PCL) The PCL (Weathers et al. 1993) is a 17-item self-report rating scale that parallels DSM-IV’s diagnostic criteria B, C, and D for PTSD.


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Dissociative Experiences Scale (DES)


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The DES consists of 28 items that describe dissociative experiences including experiences of amnesia, depersonalization, derealization, imaginative involvement, and absorption. It is a self-report measure that can be administered in approximately 15 minutes.


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Children’s Impact of Event Scale-Revised (CHIES-R)


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The impact of child sexual abuse, especially when it occurs in a family context, goes beyond simple PTSD symptomatology. In general, effects of sexual abuse on children are seen in the disruption of their emotion regulation, behavioural disturbance, cognitive difficulties, interpersonal difficulties, and posttraumatic stress reactions (Berliner and Elliott 2002). In another review of studies on the impact of sexual abuse on children by Kendall-Tackett, Williams, and Finkelhor (1993), several factors were found to lead to more symptoms, including: close relationship with the perpetrator, high frequency and long duration of the abuse, use of force, penetration, lack of maternal support at disclosure, and victim’s negative coping style. Symptom expression is also different during different developmental stages of the children. To illustrate, anxiety, nightmares, general post-traumatic stress symptoms, and inappropriate sexual behaviour are more common among preschoolers. School-age children exhibit more fear, aggression, regressive behaviour, school problems, and general mental health problems. For adolescents, depression, self-injurious behaviour, illegal acts, running away, and substance abuse are more common.


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For example, one woman felt outraged at her husband for having sexually abused their daughter, as her religion and her family all along taught her that men are head of the household who are to protect and look after the family rather than harm them. Another woman came from a social and family background where she had the belief that women are strong emotionally and have to take care of men by sacrificing and putting aside their needs, wants and rights. Though angry with her husband, she sympathized with him and worried what might become of him if he was to go to prison. She expected her daughter to follow suit and to forgive her father. The role of the therapist is not to challenge those beliefs right away, even though he or she may not agree with them. Instead, the therapist explores with the client the meaning of such beliefs — the origin of the beliefs, how the client is impacted by these beliefs in their life, whether the beliefs are helpful to or limit their choice of actions, whether the client has other more preferred values that are in conflict with their beliefs — to open up possibilities for change.


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In addition, some systemic formulations also link the mother’s deficits as partner and as parent to her family-of-origin experiences ― for example, the notion that the mother’s difficulties protecting her child once she knows about the abuse may be influenced by her own childhood experience of sexual abuse.


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Take the example of a man who has sexually abused his daughter. He may hold the stereotypical gender belief that for a man to be a man, he must not express vulnerability (e.g., feelings of pain, or need for care) nor exhibit any “female” characteristics (such as being dependent, or being empathic and taking care of others). He may objectify women and view them as secondary to men. We believe that to create more long lasting change in such a man’s abusive behaviour, it is essential to create a context in therapy to invite him to examine the rigid stereotypical beliefs that have sustained his abusive acts, so as to bring about a change towards more flexible images of manhood, in his definition of masculinity, and in his view of women.


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As noted earlier, when a child is sexually abused within the family, the trauma is not just about physiological and psychological symptoms, but is also a relational one (Sheinberg and Fraenkel, 2001). She faces confusions and dilemmas, both in her sense of self as well as her relations with other members in family. The child struggles with many relational dilemmas such as whether to tell or not to tell, if she would be believed or blamed, how to make sense of the relationship with the parent who abuses her but also takes care of her, and how to relate with the other parent who is torn between her and the family member who abuses, etc.9 The experience of being sexually abused by someone close in the family is fundamentally a betrayal and disruption of the trust and the attachment bonds between the child and her parents or caretakers. Such disruptions would negatively affect the child’s internal representations of self and relationships with others. Re-building the trust and the attachment bonds between the child and the non-offending parent or other supportive adult figures is therefore crucial to ensure that the family will become a secure base again for the child to develop trust and a positive sense of self.


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All in all, how can justice, fairness, respect, and integrity be upheld and regained in a situation in which the family is haunted by shock, shame and guilt? To address these complex relational challenges, we choose a family-based relational approach with different therapy modalities to work with children of sexual abuse and their families. Here, the idea of “relational approach in family therapy” from Sheinberg and Fraenkel (2001) in their work with families of incest is adopted.


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In the coming sections, we would discuss the relational approach in terms of different therapy modalities, namely individual work with the child, family work that strengthens the child’s relationship with her non-offending parent and that fosters the family to be a safe and nurturing place, and group work that helps to break down the sense of isolation and stigmatization often experienced by children who have experienced sexual abuse in families.10


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In the context of family child sexual abuse, the therapists’ gender may have an effect on the therapy process. For instance, in individual and family sessions, therapist of the same gender would facilitate the development of a secure context where the child or the adolescent feels safe to share her abuse experience. It also allows her to identify with the therapist and model after her in role identification. For group sessions, a co-therapy team of mixed gender is preferred whenever possible. It helps members to have experiential learning on the positive interaction between both genders and have the expanded experience that men can be supportive and caring (Fraenkel, Sheinberg, and True 1996). If co-therapy is impossible, again, a same-gender therapist is preferred.


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The primary goals are twofold: to assist the sexually abused child to overcome and reclaim her life from the negative effects of the abuse; as well as to develop safe and nurturing relationships in the family.


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The individual sessions with the child serve as a forum whereby the child can clarify and freely express her feelings, thoughts and struggles, and discuss why she finds it difficult to talk about these issues with her parents.


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The goal here is to strengthen the child’s relationship with the non-offending parent, so that the parent can support and protect the child.


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There are many reasons that the non-offending parent, apart from not being legally bound to do so, does not come for therapy. She may feel too shameful to talk to an outsider about the sexual abuse; she may be angry with the child for the disclosure; she may not believe the child or see therapy as helpful for them; or she may still be very much dominated by or dependent on the offending family member financially and emotionally, and dare not do anything to rock the boat further such as going to see a therapist, etc. In extreme cases, the child may even be rejected and ostracized from the family. To reduce the child’s sense of isolation and disconnection from the family, the therapist may have to seek out the child’s other support networks, such as inviting other significant supportive figures, a teacher, a house-parent, a friend, perhaps, to the sessions. Sometimes, the therapist may have to find ways to evoke and enrich the presence and positive influence of these other significant people who cannot be physically present.


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At the same time, the therapist also needs to strengthen the child’s sense of personal agency and help her regain a positive identity. When the child experiences significant distress or difficulties as a result of the abuse and the disclosure, the therapist needs to find ways to assist the child to overcome and get her life back from the difficulties.


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Besides, young children, because of their language and cognitive development, may not be capable of articulating their distresses and concerns through words adequately. Therapists have to adapt their ways of working to fit a young child’s development and needs. Individual play therapy can be a helpful alternative to facilitate children’s expression of feelings, confusions and thoughts.


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This is the story of Mei, a 6-year-old girl, who was sexually abused by her father. The abuse happened two years ago and lasted for a year. She only disclosed the abuse after the mother, Kwan, separated from the father. A report was made to the police but she was so fearful and embarrassed that she was not able to describe the incidents in detail. The police eventually dropped the case. When the father requested access, Mei was highly distressed. She was afraid to see her father. The mother was also scared as Mei’s father was verbally abusive and had harassed her numerous times. Mei had bad dreams, and refused to eat and go to bed. She became irritable, threw temper tantrums, hit and bit her younger brother, let her school grades deteriorate and sometimes even refused to go to school. Kwan did not understand why Mei had become so difficult and uncooperative. She coaxed her, reasoned with her and scolded her but was to no avail. Kwan felt helpless and incompetent as a mother when she brought Mei into therapy. Mei was a smart and articulate little girl, but in the early stage of therapy, she made it clear that she did not want to talk about the abuse incidents. Mei was invited to express her feelings towards the sexual abuse through expressive play therapy techniques, such as drawings and artwork. It was clear that she struggled predominantly with anger and fear. Yet, Mei did not want to say more about what she was angry and fearful about. The therapist talked with Mei about the Anger and the Fear as if they were separate entities in Mei’s life. The therapist asked questions such as what the Anger and the Fear were doing to Mei’s life, how Mei thought about the Anger and the Fear, whether she liked or disliked them, and what she wanted to do about them. The therapist invited Mei to draw pictures of what she thought the Anger and the Fear looked like. The therapist was talking in ways that externalize and separate the problem of Anger and Fear from Mei.11 Through this kind of talking, the therapist helped to create some space and distance between Mei and the problem, so that it was easier for Mei to get access to her strengths and resources to deal with the problem. The therapist did not see Mei’s identity as defined solely by the problem of Anger and Fear (thinking beyond the problem narrative) but was interested to learn more about Mei’s strengths and resources that she could use to deal with the problem. With the help of Kwan, who supplemented information and filled in details, Mei expressed that the Anger made her throw temper tantrums, hit her brother, and the Fear made her unable to sleep at night, and reluctant to go out, including Working with Familial Child Sexual Abuse 151 to school. She did not like the Anger and the Fear’s company in her life, because they made her feel bad about herself, and also made every one unhappy at home. At this point, Kwan described what Mei was like before. She told little stories of how Mei was a conscientious, caring, helpful and responsible little girl. Then the therapist asked this question, “Mei, you said that you don’t like the Anger and the Fear cling close to you, because they make you feel bad about yourself and every one unhappy. Have you got any ideas on what may be a good way to get rid of them in your life?” Mei thought for a while, and then said that the best way would be to change them into Happiness. The therapist then invited Mei to use some miniature toys to show what a happy life would be like for her. Mei liked the idea and was very involved in making what she subsequently named the Happy Kingdom, which she built in a sand box using miniature toys. In this Happy Kingdom, there was a birthday party with food and balloons, some children were playing happily, a fairy was watching over and there were lovely flowers and a rainbow. Then Mei and the therapist talked about what would be some happy activities for her (the double foci of both meaning and action). Apparently, after the construction of the Happy Kingdom, Mei was able to express more about the Anger that was bothering her. She wrote on the white board the name of her father, then she wrote “bad guy”. The same night at home, Mei told her mother that she would be happy if the police caught all the bad people. She also asked her mother why her father could walk away without any consequence despite that he had done bad things. This helped Kwan to see Mei differently. She shifted from seeing Mei as difficult and uncooperative to seeing Mei as being angry because she felt so hurt by what her father had done, and because she felt so unfair that her father could get away without any consequences. In the following weeks, Mei did gradually turn Anger and Fear into Happiness. She told the therapist that she had moved to live in the Happy Kingdom. She said that as long as she did the good things that she used to do, she could shut out Anger and Fear from the Happy Kingdom. She and her mother then gave the therapist a list of the good things she did, including studying hard, eating meals, going to bed on time, engaging in happy activities (reading story books, playing on the computer, playing with her brother) and talking to her mother. At this juncture, the therapist was interested in fostering a different sense of identity for Mei. When the therapist asked what it meant for her to be able to regain happiness after so many difficulties, Mei said that this must mean she was a happy person, as a happy person would try to be happy even when things were bad. Kwan joined in and told the therapist that actually the family used to nickname Mei “Smiley” when she was small, because she had those abilities to bring happiness to people around her, and Kwan gave many examples. The meaning of being “Smiley” was interweaved with daily examples of actions (double foci of meaning and action). Kwan’s sharing helped to enrich and reinforce this happy 152 Ellen Yee-man Ma and Delphine Cheuk-wai Yau self that Mei was re-discovering in herself, and obviously a more preferred self for Mei. As a ritual to commemorate Mei’s rediscovery of this more preferred identity, “Smiley”, the therapist invited Mei to make a citizenship card of the Happy Kingdom for herself. Mei was enthusiastic about the idea. She eventually designed one for herself, one for her mother and one for her little brother. She proclaimed that she, her mother and her brother were the first three citizens in the Happy Kingdom! In the next session, Mei came in and announced that she wanted to draw pictures to show the therapist and her mother what her father had done to her. She had never told the incidents in full before. Mei was a bit embarrassed, but she felt proud of herself in being able to tell, through drawing, what had happened. Apparently, the happy identity had made it possible for Mei and given her strength to tell the abuse incidents. Kwan’s changed understanding of the meaning of Mei’s anger was also pivotal in changing the way she responded to Mei’s “uncooperative behaviours” at home. Kwan was more supportive, patient and understanding. Unfortunately, when things seemed to get better, the court requested the social worker to arrange for access of the father to Mei. Mei’s distress level intensified after she met the father under the social worker’s supervision. She was unwilling to go to school again, vomited if made to eat, shivered, was jumping around, and was unwilling to sleep. Eventually, Mei confided to her mother that she had to keep moving around and making sounds, because if she quieted down, she would see scary things. In the session, the therapist had some externalizing conversations with Mei on the scary things. Supported and encouraged by the mother, Mei was eventually able to tell them that she saw a dark human shadow with no hands and feet, usually before she went to sleep or when it was quiet all around. The therapist then asked Mei, “Where do the scary things appear, in your mind, or before your eyes like I am sitting in front of you now?” Mei replied that the scary things appeared inside her head. The therapist and Mei then had some discussions on whether the scary things were real or not since they only appeared inside Mei’s head, why they would want to keep Mei afraid, what they were up to by tricking Mei into believing that they were real, whether they had any real power to hurt Mei, etc. Instead of telling Mei not to be afraid since the scary things were only images in the head, the therapist gave Mei the space to figure out on her own that they were not real. The externalizing conversations also made it possible for Mei to discover that as long as she was not afraid, the scary things had no real power over her. With the assistance of her mother, Mei came to the conclusion that she must have a smart brain to be able to see through the tricks of the scary things and figure out that they were not real. This preferred identity of Mei, as someone with a smart brain, also made it possible for Mei to make the decision, at the end of the session, that she would not let something unreal mess up her life. Working with Familial Child Sexual Abuse 153 After this meeting, the scary things reduced their appearance in Mei’s life significantly, but Mei was still hitting her brother. At this point, Mei was able to articulate clearer what she was angry about. Mei asked forcefully why someone could do bad things and did not need to face any consequences, why she had to be good and considerate so as not to make others unhappy while that person (referring to her father) did not need to care for people, and what the point was for her to be a good kid. It was clear that Mei was angered by how unfairly she was treated. She was angry that her father denied the abuse, accused her of making things up, and even harassed her mother. She was also angry that not only did the adults and the police do nothing about her father’s abuse but they made her see him against her will. Having understood the meaning of Mei’s anger, the therapist was curious what might be important to Mei that was taken away by the abuse and by the way the abuse was handled, which led to her outrage. Kwan, at this point, was really good at reading beyond the problem and understanding the meaning behind the problem. She said that Mei really valued being fair and responsible, and the abuse violated these important values of hers. Kwan gave some daily examples of how Mei would keep her words, how she tried to play fair in games and treat her friends fairly, how she was willing to accept discipline when she did something wrong, etc. Kwan’s descriptions acknowledged Mei’s outrage. Kwan added that she and Mei’s teachers all liked these qualities of Mei and it would be a real pity if Mei let the Anger take away her precious qualities. With the help of the mother, a more preferred identity of Mei being a fair and responsible child was rediscovered and developed. Very amazingly, several days after this session, Mei told her mother that she would not be so stupid as to fall for the trap of Anger, and let Anger make her sick (vomiting, not eating or sleeping) and unhappy. She also would not let what her father did to her ruin her life and make her unable to do important things, such as going to school, taking care of her own daily routines, doing happy things, and being a nice sister. It seemed that Mei was able to use her smart brain to figure out ways to transcend the anger so that she could continue to have a happy life. She was living out the several preferred identities that she, her mother and the therapist had talked about — being a conscientious, caring, helpful and responsible child, being a happy person (“Smiley”), and being someone with a smart brain. Although the individual work with the mother is not the focus in this section, suffice to say is, Kwan came to realize that she had also let fear dominate her attitude towards her ex-husband. Fear had interfered with her commitment to protect Mei. Mei’s courage in telling the abuse incidents had also inspired Kwan to be courageous to fight for herself and her daughter if they wanted a happy life. She was determined to take action in the court to fight for a fair share of property (before, she had planned to ask for nothing from her husband) and to apply 154 Ellen Yee-man Ma and Delphine Cheuk-wai Yau for temporary suspension of her husband’s access, even though she knew that he would be angry and perhaps retaliate. As a passing note, the therapist also liaised with the social worker on the issue of the visitation. The therapist worked with the larger system to advocate for Mei’s interests. Eventually, the court granted temporary suspension of access. A few months later, Kwan succeeded in obtaining her ex-husband’s consent through the court and took the children abroad to study.


– Highlight Loc. 3435-38

Individual work with children whose relationship with the parent is strained For children whose parents do not fully give them support and blame them after the disclosure, and for children whose family members do not participate at all in therapy, the therapist has to face many challenges. The hardest challenge is how to work with these children, who are isolated, unsupported, and disconnected, in ways that would help to foster a greater sense of personal agency and reconnect them with supportive figures.


– Highlight Loc. 3441-46

Sui’s mother did not believe in Sui’s accounts. She believed that Sui had sex with her boyfriend and then made up a story of sexual abuse by the father to protect herself from being reprimanded or beaten up by the father. The mother and the two younger siblings were angry with Sui for accusing the father and believed that he was innocent. Sui was the only person whom the therapist could see because the family members refused to participate in therapy. After the disclosure, Sui had to live in a children’s home. She was under undue stress for being disbelieved and blamed, as well as having to leave home. Feeling lonely and rejected, Sui tried to kill herself by swallowing sleeping pills.


– Highlight Loc. 3467-3516

However, as the court date drew near and Sui had to take the witness stand since her father did not plead guilty, anxiety and guilt got an upper hand in Sui’s life. She had the dilemma of whether to withdraw from being a witness. On one hand, she felt worried and guilty upon seeing her mother’s and her siblings’ distress about the father’s possible imprisonment. Sui was especially worried about her mother who had weak health. On the other hand, Sui was also very angry at the father’s denial. She felt it was unfair that her father got all the sympathy while she was blamed and rejected by the family. She very much wanted to gain some justice through the court’s ruling. This time, although Sui was under a high level of distress facing the pending court hearing, she firmly told the therapist that she would not harm herself as a way out. Nonetheless, the high level of distress had real effects on Sui’s daily life. She had trouble sleeping at night and had bad dreams, felt she was stared at when she went out, and heard voices calling her name. Sui was worried that something might be wrong with her. She was most troubled by the “voices”, which disturbed her daily routines. Sui was referred for a psychiatric consultation. The psychiatrist reassured her that she was just being stressed because of the circumstances and there was no need for medication. This was relieving for Sui, but she still wished to discuss with the therapist how to deal with the voices. 156 Ellen Yee-man Ma and Delphine Cheuk-wai Yau Instead of giving advice to Sui on how to deal with the problem, the therapist tried to engage Sui in conversations that would assist her to discover her skills and strengths to cope with the problem (enhancing Sui’s personal agency and the belief that Sui was not just a passive victim). The therapist explored the effects of the voices on Sui’s life, her reactions to them, the times when the voices would be stronger or weaker, the power the voices had over Sui’s life, etc. Sui gradually realized that the voices were able to affect her because she chose to listen and attend to them. It came down to a matter of her choices of how she wanted to attend to the voices. She was certain that the voices were just inside her head and if she chose to ignore them, they would not affect her much in her daily routines. She felt that she could just treat them as noises. In the following session, Sui told a funny story of how she thought that the voices were calling her again while she was reading a book and therefore she ignored them, only later to find out that the houseparent was really calling her name from the living room. Sui had a good laugh together with the houseparent. Sui discovered that the voices could not disturb her when her mind was fully engaged, which was when she was solving mathematical problems. She even jokingly told the therapist that she had to thank the voices for helping her spend more time to study mathematics. After these conversations, the voices, though still present in Sui’s life from time to time, appeared less often, and were less disturbing. Sui also slept better at night. Sui still struggled with the dilemma of whether to appear as a witness in court. One week prior to the court date, Sui ran into her father when she went back home to get some personal items. The father scolded Sui and told her to leave. Sui was very angry and began to question whether it was worthwhile for her to make sacrifices for a man who had not showed the slightest hint of remorse. The therapist did not take Sui’s anger for granted, but explored with Sui the meaning of her anger in the hope of opening up conversations to rediscover Sui’s preferred life story alongside the story of abuse. For questions such as what made her so angry at her father’s response, why this would have her rethink about taking the witness stand and plan to withdraw as a witness in court, and whether the anger might be related to some important beliefs and values of hers that were being violated by her father’s act, Sui pointed out that it was important for her that people should be responsible for their actions. She continued to talk about why responsibility was important because her father had never been responsible to the family and he often put his own needs first. She saw how hard her mother’s life had been to support the family. Sui was able to acknowledge her mother’s contribution to the family by being a responsible wife and mother. She began to link the value of responsibility, which she held as important, to her mother’s influence on her. This subsequently had the effect of softening Sui’s anger towards her mother for not believing and supporting her. The therapist asked Sui Working with Familial Child Sexual Abuse 157 if the value of responsibility had any relationship with her belief that one should make choices for one’s life. Sui, after thinking for a while, agreed that the two were related. She explained that the true meaning of making choices for one’s life also included the notion of bearing responsibility for the choice one had made. The therapist and Sui had more conversations around this further reinforced preferred identity of responsibility and making choices for one’s life. As Sui talked more, she realized that actually disclosing the abuse was not the first time she made choices for her own life. She had a history of doing this, such as choosing to enroll in her present school despite her mother’s opposition, dating her boyfriend though her parents were opposed, opting for the science stream though her teachers thought that her grades were not good enough, etc. After a while, the therapist asked Sui this question, “So, you have made choices at different points in your life, and you have stood up to opposition and disapproval from others to live out your choice. You also value taking responsibility for one’s action. Now, what if you use this value and this belief as guidance in your dilemma about whether to be a witness in court next week? What are your thoughts?” Sui very quickly responded that her father should take responsibility for what he had done. Sui was still worried if her mother could take the blow of her father’s possible imprisonment, but she could better differentiate that it was her father’s actions which had caused her mother’s suffering rather than hers. Sui decided to take the witness stand. As an ending note, Sui took the witness stand, as she said. She was proud of her performance as a witness, especially her ability to outsmart the defense attorney without falling into the traps of his tricky questions. Eventually her father was sentenced to 4 years’ imprisonment. Sui also took a more understanding and compassionate stance towards her mother. She could appreciate what her mother had done for the family, and gradually was able to let go of her anger towards her mother. In a few months’ time, the mother also let Sui stay with the family for home leave.


– Highlight Loc. 3517-22

In working with children who struggle with significant level of distress as a result of sexual abuse and the disclosure, the first and foremost consideration is to build up a secure and safe care-giving environment for the child. This would enor-mously help the child recover from the trauma of the sexual abuse, and would also safeguard the child from being re-abused again. If the child is still at risk of abuse, there is no way she can overcome whatever difficulties she is experiencing. However, in the local setting, the non-offending family members are often not available for therapy. The therapist then has to explore, invite or invoke the presence of other supportive figures, and work to build up the child’s connection


– Highlight Loc. 3523-27

Secondly, the individual work has to address and enhance the child’s sense of personal agency. When the child sees herself differently in the preferred life story of resources, strengths and skills, there are more possibilities for change and for expanded meanings of the experience of abuse. The preferred life story then becomes a platform and makes it more possible for the child to break away from the distressing effects of the abuse. Thirdly, the therapist has to be flexible in working with children. For example, when working with young children, the therapist has to adapt his or her ways of working with more child-friendly methods so as to fit with the child’s developmental needs.


– Highlight Loc. 3528-32

Goals of family sessions The major goals of family work are, firstly, to strengthen the relationship between the child and her protective family members, such as the non-offending parent or other adults who assume the parental role in the child’s life, and secondly, to make safe the relationship between the child and the offending parent. When working with the family, it does not mean that the whole family has to be seen together in every session. Individual work with the non-offending parent is indispensable.


– Highlight Loc. 3533-38

Disclosure of child sexual abuse in a family can be equally shocking and confusing to the non-offending parent, usually the mother in most cases. The emotional turmoil around the abuse allegation, the protective role of being a mother, the attachment towards as well as the sense of betrayal by the partner, the possible split-up of the family, the financial and social changes, and the blame and pressure from relatives or family of origin are all real challenges to the non-offending parent. For a non-offending parent, a common response in hearing the abuse for the first time is shock and disbelief.


– Highlight Loc. 3547-49

The beliefs that “family matters should be resolved within family” and “one should never be involved with the court/legal system” are common among Chinese people. She was torn by the split loyalty between her daughter and her husband and the issue on whom she should believe and trust.


– Highlight Loc. 3568-69

To solicit the non-offending parent’s support for the daughter, the therapist has to validate her conflicts in facing the betrayal of her husband as well as her attachment towards him as her lived experience.


– Highlight Loc. 3569-77

For Li, it was difficult to share with others her concern for a man who sexually abused their daughter without anticipating shame and disrespect in return. If she told others of what had happened, she would likely get a story of shame, in that she had chosen a “wrong guy” as her husband, or she could not “satisfy” him as a wife. “Married to the wrong guy” is considered one big failure for women in Chinese culture. When sexual abuse occurs in family, one common attribution is that “the couple has problem in their sex life” or “the wife cannot satisfy her husband in sex”. The therapist has to be careful of beliefs that subtly justify men’s abusive behaviour by blaming women. In Li’s situation, the therapist and Li together explored and examined her beliefs in gender, family hierarchy, marriage and love; and how these beliefs were related to her sense of shame. Moreover, the therapist also worked with Li on issues of anger and shame in relation to her daughter’s disclosure to people outside the family, before Li were able to understand and support her daughter emotionally. All these issues are better worked with the non-offending parent individually.


– Highlight Loc. 3583-85

Another important area of therapy is to understand the non-offending parent’s childhood experience with her own parents. This helps the non-offending parent to understand how her parenting practices are affected by or modelled after her experience with her own parents, so that she can make a conscious choice in her current parenting practices.


– Highlight Loc. 3596-3606

In working with the non-offending parent, we find that asking “If” questions are helpful to bypass the denial or the minimization, to expand the mother’s perceptions and to assist her to get in touch with her emotions that are difficult to express. For instance, instead of falling into an argument with the mother, the therapist may ask “If the abuse had really happened, what do you think would be the consequences? How would you and your daughter be affected?” Sometimes, not all non-offending parents are like Li, ready to make a moral choice. Some simply refuse to trust their daughters and participate in therapy. When working with the non-offending parent is impossible, other supportive adults have to be identified so that there is still someone in the child’s life with whom she can develop a trusting relationship. Lastly, the impact of sexual abuse on the child vary depending on her age and development. Sometimes, it may be helpful to assist the non-offending parent to realistically understand the impacts of the abuse on her child in light of her age and development. The non-offending parent may be so overwhelmed by the disclosure that she loses sight of the needs of her child. When the mother is able to understand her child’s reactions and to relate with the child in ways that support her developmental needs, this helps to strengthen their mutual trust and lessen stress and conflicts.


– Highlight Loc. 3616-19

The therapist needs to discuss with both parties on what materials they want to bring from their individual sessions to the joint sessions. Such discussion is called Decision Dialogue (Sheinberg and Fraenkel 2001). It is important in the sense that both can participate in the decision on when to talk what, which is empowering to families who, having gone through the experience of sexual abuse, are often left with a sense of powerlessness and helplessness.


– Highlight Loc. 3628-39

In summary, in the story of Li and Ling, the therapist chose not to confront the mother about her disbelief of abuse in the first place, but rather tried to understand what might be contributing to her dilemmas and struggles. The therapist then heard a story of love and the importance to find one’s own happiness, as well as an alternative story of strength in mothering practices that had existed Working with Familial Child Sexual Abuse 163 in generations. The therapist was thinking beyond the problem narrative of the mother’s disbelief and blame and rediscovered in her preferred stories of strength and finding one’s own happiness. This became a different platform in the joint session in which Li was able to support Ling and the two were able to connect emotionally. The mother could also make a moral choice. Both Li and Ling were no longer dominated by the story of shame around the abuse. The rediscovered stories and the values that they treasured helped to build up their preferred identities and their connections to one another. This made it possible for Ling to change her perception towards her mother. Li was no longer a primitive mother, but a mother committed to her family and children. Listening to her mother’s story and the strength that the three generations of women possessed, Ling felt proud and connected with the women in her family line. In the individual sessions with Ling, she showed more capacity to understand her mother’s conflicts and to let go of her anger towards her mother for not believing her in the first place. Ling became less irritable at home.


– Highlight Loc. 3661-63

Being influenced by the traditional Chinese values about the different roles of men and women, and the importance of the firstborn son in a family, he worked hard as the sole breadwinner of the family, and he often favoured the elder son,


– Highlight Loc. 3664-65

Preoccupied with both shame and fear of losing his son, Wong was depressed and irritable.


– Highlight Loc. 3668-82

With this understanding of how the abuse incident had affected the family members’ relationships by locking them in a cycle of negative interactions, and with the knowledge of Wong’s values of honesty and responsibility which he took pride in, the therapist first showed respect for the contribution he had made to his family, as well as acknowledged the expectations he had for his son and the attempts he had made to approach Fong. The idea of manhood and what constituted a responsible man in a family and society were then raised with Wong and Chun. Wong took pride in having treated his wife well and in having provided the family with a secure living. He spoke of what he believed a responsible man should be like, in which one of the qualities was to know how to respect women. When asked what he meant by respecting women, he replied, “Such as not to touch them indecently.” “So, how would you help your son grow up to be a responsible man so that he knows how to respect women?” the therapist asked. This opened up a dialogue that changed the meaning of his son’s removal from Working with Familial Child Sexual Abuse 165 one of losing him to one of helping him to learn to be a responsible man through the programs and counselling offered by the social worker. It also helped Wong see the importance for his son to take responsibility for the abuse, if he was to learn to be a responsible man. With this changed perspective, both Wong and Chun were able to recognize each other’s contribution in raising their children and establishing a family together. Through the conversations, the father’s life story and identity were no longer dominated by a story of shame and loss, but were expanded to include a story of pride and responsibility. With this expanded perspective, he had more capacity to understand the impact of abuse on Fong and to show more patience of Fong’s need for personal space at home. “Let me die!” was no longer heard in the family. Quarrels between the couple were much reduced.


– Highlight Loc. 3687-95

she would do her best to protect Fong in future. With this reassurance, Fong then told her mother why she did not disclose the abuse earlier. She was worried that her parents would not believe her, as she perceived that they had favoured Wai over the years. She then let her mother know her need for personal space at home. With the help of the therapist, she told her mother the stress she had during the disclosure and she reassured her mother that she would not hurt herself again. All these issues had actually been discussed in the individual sessions with Fong prior to the joint session, and Fong had agreed to tell these to her mother in the joint session with the therapist’s assistance. The mother and the daughter then had a discussion on what to do in their daily life so as to regain and rebuild their confidence towards one another. When the mother and the daughter were connected through their shared pain and reassurances of support rather than fear and blame, their perceptions of the relationship and their interactions changed. They were less irritated, fought less and had more understanding of each other.


– Highlight Loc. 3695-3700

In short, the primary goal of joint sessions with the child and the non-offending parent(s) is to strengthen their relationship and to rebuild trust between them, so that they can dissolve the difficulties brought by and heal from the negative 166 Ellen Yee-man Ma and Delphine Cheuk-wai Yau effects of the sexual abuse. To achieve this, the therapist has to work on the blocks that hinder the non-offending parents’ capacities to be empathic with the abused child. The non-offending parents’ overwhelming emotions towards the abuse, their fears and worries, their dilemmas and conflicts, their life experiences, their beliefs that affect the ways they respond, and the values that they cherish despite the abuse, all need to be explored and addressed.


– Highlight Loc. 3704-7

the therapist has to stand on a clear moral position that the perpetrating family member has to take total responsibility for the abusive acts. Other family members, including the child, are not to be blamed for the abuse. The therapist has to be conscious of the exercise of power by the perpetrating family member, usually the father or the father figure, over the child and how other factors such as gender beliefs and family roles help to maintain the power distribution in the family.


– Highlight Loc. 3708-25

we would state only the criteria that the offending family member has to meet before a joint session with the child and the non-offending parent is held. The first and foremost criterion is that the perpetrating family member takes total responsibility for the abuse. He makes no excuses, which sometimes can be subtle, for the abusive acts. An example of subtle excuses would be for a father12 to say, “I’m sorry for what I did. I was abused as a child, and I think I was messed up. I would never do this to you again.” For the apology, he can either apologize in the form of writing if he and the child cannot meet; or face to face with the child and the mother in an apology session if the child is ready to accept his apology. He has to learn to be empathic to the impact of abuse on the child and other family members. He also needs to be aware of how he has made use of his position in the family to exert his power in an abusive way. Furthermore, he has to commit himself to what he would do to ensure that he would not offend again. Secondly, it is important that he does not pressure or induce the child to feel pity for him and thus to forgive him. The distinction between a self-centred apology and an other-centred apology is important (Jenkins, Joy and Hall 2002). When the father focuses on his own suffering or apologizes for a particular end result, even though he admits his abusive behaviour, he is still prioritizing his own interests and needs over the child’s needs. In a self-centred apology, a father subtly puts pressure on the child and the partner to pity or forgive him, perhaps Working with Familial Child Sexual Abuse 167 by saying how miserable or painful he has felt, for example, “I know I do not deserve to be forgiven, and I cannot forgive myself too. I would carry the pain for the rest of my life.” Another example of a self-centred apology would be a father who apologizes as a means to achieve reconciliation. “I am very sorry for having hurt you. I promise I will change myself and never do this again. I hope we will work together for a better family.” If the perpetrating family member truly owns up total responsibility, he will prioritize the child’s best interests over his, and there are no strings attached to his apology. He understands and accepts that his apology does not entitle him to any specific responses he desires to have from his family members.


– Highlight Loc. 3725-31

In preparing for an apology session, the therapist has to make sure that the offending family member, the child, and the non-offending parent are all ready for the meeting; and that they are ready to talk about how to build safe relationships in the family. The child also participates in the decision whether to forgive or not and whether she wants such a session. The goal of an apology session is not for family reunion, but for the interests of the child. The therapist needs to be sensitive to the child’s voice on this issue, since usually children lack the negotiation power to assert their preference in the family. Sometimes, a child says yes for family reunion simply because she knows that her mother wants it, and she does not want to risk losing the mother’s love by opposing her wish.


– Highlight Loc. 3749-51

Chun shared that although there were some adjustment and embarrassment at the beginning, Wai kept his word on what he had committed to do, such as not staying alone with Fong and not going into her room.


– Highlight Loc. 3752-56

In cases where the offending family member denies the abuse or is imprisoned, or where the non-offending parent decides to separate from her partner, apology from the offending member is not likely. Under these circumstances, the therapist has to work with the child on how she perceives the offending family member’s denial or justifications, how to separate herself from self-blame, as well as how she can regain justice and a positive sense of self with the support of other persons in her life.


– Highlight Loc. 3756-65

From the above stories, it can be seen that each family and each person makes meaning of the experience of sexual abuse differently, and hence is impacted differently. The therapist needs to understand how beliefs in gender and family roles, family interactions, and the meanings constructed about the abuse influence the family’s perceptions and responses to the sexual abuse. Bearing these in mind, the therapist engages the non-offending parent(s) to explore their dilemmas and clarify their confusions, invites them to expand their capacities to understand the child’s feelings and needs, and facilitates them to make a moral choice. In addition, the therapist also has to work on changing any negative patterns of interactions among family members so as to restore a safe and nurturing family relationship for the child. Last but not the least, work with the offending family member is of salient importance in the safety and recovery of the child and the non-offending family members. Although this work is currently very difficult Working with Familial Child Sexual Abuse 169 to be implemented because of limitations in the social and legal systems in the local context, wherever possible, the offending family member should be invited and engaged in therapy.


– Highlight Loc. 3766-69

Bringing children who are rejected by their families together in groups helps to break down their sense of isolation, disconnection and stigmatization. In the earlier sections, we have talked about the importance of fostering supportive and nurturing relationships for the sexually abused children with other significant figures if family members are not available. Groups are another valuable option here.


– Highlight Loc. 3770-79

In facilitating groups for sexually abused adolescents,13 the same core ideas that are discussed in the earlier section apply. One central principle in the family-based relational approach is for therapists to interweave information among different therapy modalities (individual, family and group sessions) when working with sexually abused children/adolescents and their families. It is therefore preferable that the same therapists who see the adolescents individually act as therapists for the group. We find that it is also easier for the adolescents to speak up as they already have some familiarity with the therapists. It also seems to work best if the group members share common experience, such as being rejected and blamed by the family, being close in age with one another, and experiencing similar severity in the abuse. Where possible, it is helpful to recruit some group members who have already reclaimed some aspects of their lives from the effects of the abuse, so that they can share stories of hope and strength with those who are still in the turmoil and struggling with difficulties. In addition, ensuring certain degree of structure and predictability of the group helps the members to feel safe. Safety is fostered through regularity of time and place to meet, clear guidelines of conduct for group members, and similar structuring of each group meeting into components such as checking in, discussion of a particular theme, and closure.


– Highlight Loc. 3783-89

Artwork can be a useful adjunct for discussion of the difficult subject of sexual abuse. In one group, the members found art activities like making collages to introduce themselves and to express their feelings and thoughts about the abuse in the early meetings helpful both as an icebreaker and also to lessen the initial anxiety. Sometimes artwork helps to instill a sense of cohesion and shared purpose in the group. One group came up with the idea of having a symbol of a Flying Heart to represent the primary group value of “Love, Hope and Freedom”. This group, with a member talented at needlework, made the Flying Heart to be displayed in every meeting. The therapists often make sure that an array of art materials is available for use in the group meetings. Group members are given the option of using artwork as an alternative medium of expression in addition to the use of language.


– Highlight Loc. 3789-94

The use of food Food is another important element that the therapists include in every group meeting. Food is a symbol of nurturance and sharing. In the Chinese culture, families and friends enjoy the sharing of food to enhance the sense of mutuality and togetherness, whether on daily occasions or during special times. In our groups, the adolescents usually sit at a round table, sharing snacks while talking about the difficult topics. They also participate in deciding the snacks they would like to have. Sometimes, some group members brought food they made to share with the others. The therapists always take care to instill an atmosphere of care and mutuality in the group sessions when difficult topics are being brought up for conversations.


– Highlight Loc. 3795-3801

Inclusion of the larger context One important topic that is usually brought up for discussion in the groups is: how the larger context has made the group members’ experiences more difficult (the core idea of “social context in the life of problems”). The group members are invited to reflect and discuss how the negative societal responses and gender beliefs influence them to think negatively of themselves. Some examples of the negative social and gender beliefs that were discussed in the groups are: women are responsible for the sexual assault because of the way they behave and dress; or sexually abused girls are inferior or damaged. The group members are invited to discuss the effects of these beliefs on them, what positions they want to take, how they want to respond to these societal responses and beliefs, and whether they find these beliefs helpful to them.


– Highlight Loc. 3801-17

Discussing the effects of abuse: the use of metaphors and thinking beyond the problem narratives The other topics often brought up for discussion in the groups are self-blame, guilt, shame, confusion, fear, anxiety, anger and self-harm, namely the many difficult effects of the abuse and of disclosure the group members struggle with. The therapists facilitate the groups to speak of the difficulties in an Working with Familial Child Sexual Abuse 171 externalized way, as in Mei’s story in the section, “Individual work with young children”. Metaphors and symbols are used to represent the different topics for conversations. Some of the metaphors that we have used in the groups include: a dumping ground in which the members put down the burden of secrecy, a swamp in which the group talked about ways of getting free from the quicksand of self-blame, a dense forest in which the group found their ways out of confusion, a big hand that represented conversations about breaking free from the tight grip of guilt and shame, a candle that symbolized hope against fear, and a “wonderland” that represented the end stop where the group would find new skills and abilities and new preferred stories of strength. Externalizing the problems by speaking in metaphors puts a distance between the adolescents and the difficulties they are struggling with. In turn, this makes it easier for them to notice ways and steps that they have used or can use to overcome the problems. It is important that the therapists think beyond the problem narratives and listen to the group members on a double level. The therapists not only listen to the group members’ painful experience of the abuse, but also take note of how the group members have struggled and taken steps to stand up to the effects of sexual abuse. The therapists enquire the values, beliefs, hopes and commitments that have supported the adolescents in taking those steps to reclaim their lives from the effects of the sexual abuse. These values, beliefs, hopes and commitments speak to the adolescents’ more preferred stories of strengths, resources and pride. Connecting the group members’ lives through shared values, beliefs and hopes help to reduce their sense of isolation tremendously and enhance their sense of personal agency.


– Highlight Loc. 3824-29

Some more examples of the values, beliefs and hopes shared by the group members are: the belief of the importance of connections, the commitment in fairness, the belief to hang on even though things are tough, the hope to live their lives free from the effects of abuse one day, and the value of compassion and 172 Ellen Yee-man Ma and Delphine Cheuk-wai Yau empathy arisen from their suffering. After these conversations, the group members gave the feedback that they felt stronger, freer, happier, less lonely, more hopeful and more confident that they would overcome the difficulties brought by the sexual abuse.


– Highlight Loc. 3835-42

The importance of creating hope To instill a sense of hope, as aforementioned, it helps to have some group members who have already established some aspects of their life free from the effects of abuse to share their stories with those who are currently in struggles and turmoil. From our experience, we also find that the journey metaphor is useful in creating hope (McPhie and Chaffey, 1998; White, 2002). The group is likened to a journey. The members set off on a journey to explore different places (the discussion topics) and they all share a common hope that they will reach the “wonderland” where they will find new skills and knowledge about themselves, as well as strengths and resources that help them survive and surpass the negative effects of abuse. As a note of caution, we do not want to give the wrong impression that the process of traveling to this “wonderland” is easy and smooth, as our writing may sound. The process is full of setbacks and difficulties instead.


– Highlight Loc. 3844-46

The journey metaphor makes it easier for the group members to notice the steps they have taken, however small, when they compare the place they are currently at to the place they start off initially. The steps they have taken become the foundations to open up conversations for more preferred stories of strengths and pride.


– Highlight Loc. 3848-52

Rituals help to Working with Familial Child Sexual Abuse 173 build up group solidarity and also help to consolidate and strengthen the preferred identities and stories. Sometimes, it is in the format of an award presentation cer-emony (for example, an award may be presented to congratulate a member for her bravery in standing firm on her belief in fairness and in taking the witness stand in court), or a feast celebration. All members participate in deciding what they feel would be a meaningful ritual for them.


– Highlight Loc. 3871-72

in most cases of familial child sexual abuse, the offending family member is usually a male. When the offending person is a parent, it is usually someone in the father role, while the non-offending parent is usually the mother.


– Highlight Loc. 3876-77

“Collaborative Therapy: Relationships and Conversations That Make a Difference”.


– Highlight Loc. 3883-85

The externalizing way of talking about problems is a skill in narrative therapy. Readers who are interested can read more about the skill of externalizing conversations in Alice Morgan’s book “What is Narrative Therapy”


– Highlight Loc. 3974-83

In an attempt to differentiate the heterogeneous batterers population, Holtzworth-Munroe and Stuart (1994) have identified three dimensions which are found consistently to differentiate among subtypes of batterers: severity of violence, generality of violence, and psychological functioning. On the basis of these dimensions, three main types of male batterers are suggested, namely, (1) family-only, (2) dysphoric/borderline, and (3) generally violent/antisocial. The “family-only” batterers, estimated to constitute 50% of batterers, engage in the least severe violence and show little evidence of psychopathology or personality disorder. The “dysphoric/borderline” batterers, estimated to constitute 25% of the batterer samples, engage in moderate to severe wife abuse and in violence outside the family; they are involved in other criminal behaviour and likely to have borderline and schizoid personality features. Finally, “generally violent/antisocial” batterers are estimated to constitute the remaining 25% of batterers who engage in moderate to severe violence to their partners as well as outside their family; they have extensive criminal records and are likely to have substance abuse problems, antisocial personality, or psychopathology.


– Highlight Loc. 3986-87

There is also apparent consensus in the literature that partner violence is a very complex problem which indicates the need for a multidimensional explanation


– Highlight Loc. 3989-95

According to the theory, there are four levels of analysis for the characteristics of batterers, namely, the macrosystem, which refers to broad cultural values and belief systems such as patriarchal values; the exosystem, which refers to the formal and informal social structures (such as job stress, low income, unemployment, and the presence or absence of social support systems) imposed on the immediate settings of an individual and thereby influence his behaviour; the microsystem, the immediate context in which wife assault takes place and factors such as the couple’s communication and interaction pattern, their conflict issues, their power differential, and the process of assault; and ontogenetic factors, which refer to the individual’s developmental experiences with violence that shape his responses to the three-level social context.


– Highlight Loc. 4000-4005

The “internal experiences point of view” examines the men’s expectations and frustrations in intimate relationships; violence is believed to be used by the men as an attempt to protect themselves from being overwhelmed by emotions arising from the frustrations (Goldner et al. 1990; Chan 2000). The “interpersonal point of view” studies the men’s violence in the context of relationship conflicts and power struggle between the partners (Chan 1996). Finally, the “interventionist point of view” focuses on combating the men’s violence and proposes various strategies to change the men (for example, Emerge 2000; Pence and Paymar 1993; Geffner and Mantooth, 2000).


– Highlight Loc. 4020-22

It consisted of two stages: the first stage was a seven-session psycho-education which aimed at educating the batterers on the nature and consequences of partner violence and motivating them to take up the responsibility for change; the second stage consisted of 14 sessions and aimed at a more in-depth review and management of the men’s individual and marital problems underlying their violent behaviour.


– Highlight Loc. 4052-53

The focus here was on the men’s physical violence.


– Highlight Loc. 4069-78

These intermarriages have also been fostered by the men’s difficulties or reluctance in finding partners in the city and the women’s expectation to seek a better life in Hong Kong, an expectation that was somehow shared by the men or their parents in the past. These men and women were therefore joined by their wish for a family and their idealistic expectation to have a way out and improve their living standards. A typical marriage between a Hong Kong man and a Mainland woman in this sample was a blitz union between the partners who were introduced to each other and then got married within days or weeks. There was no dating or courtship, not to mention any romantic love, between them. After their marriage, they lived separately, with the man working in Hong Kong and the woman looking after the children in the Mainland. They were then united in Hong Kong after some three to ten years after their marriage. However, in spite of their union, they were yet to be united in many other ways ― their daily routines including their financial management and family roles differentiation, their own relationship and father-child relationships, their culture, and so on. Indeed, these men and women have a huge variation in their cultural or ethnic background. They had different family origins


– Highlight Loc. 4079-82

Such a difference represented, among other things, the men’s variation in their male-dominated kinship system and patriarchal values which are still prevalent in many rural parts of the Mainland, the women’s attachment with their own kin, and their exposure and openness to Hong Kong’s relatively modern values in gender equality and social justice. At a micro-level, the difference also had an effect on how the men and women manage their personal and family problems in their everyday life.


– Highlight Loc. 4197-98

TIN’s case illustrated one phenomenon that was clearly evident in this research, namely, the men’s longing to establish their own family.


– Highlight Loc. 4203-4

However, the male batterers in this research sample clearly subscribed to a family culture in the sense that they had been striv-ing to find their family, although the subjective meaning of family may vary from one man to another.


– Highlight Loc. 4205-11

In the majority of the cases, the men’s longing for family could be traced to some miserable personal and family experiences in their past, which had fostered in them a heightened and reparative wish to find their own family. In TIN’s case, he had endured a lonely childhood, rejected by others because of his psoriasis, and a failed marriage in the past. In KEN’s case, during his childhood he had been severely abused by his stepfather and frequently bullied by schoolmates of Triad backgrounds; when he entered adolescence, he went through a long and lonely struggle to wean himself from the habit of seeking sexual gratification by groping girls while in crowded places. For another man LIU, he came from a poor family in a Mainland village, which was labelled as having a “bad element” ― his father being a veteran from the Kuomintang. His family was victimized and LIU used to be bullied and hit by others, and his arm was once broken in a fight.


– Highlight Loc. 4217-23

From the outset, the men’s endeavours to establish their own families was an attempt to fulfill their reparative wish. But on a deeper level, they were apparently hoping that the intimate relationship could provide a healing to their emotional wounds and suffering that they endured in the past. For example, TIN was expecting from his wife an exclusive relationship in contrast to his childhood loneliness and rejection; KEN was expecting his girlfriend to provide him with a kind of unconditional acceptance and support in contrast to the childhood abuse and social judgment for his offending behaviour in his adolescence and early adulthood; and LIU was expecting from his wife intimacy and care to compensate 190 Chung-ming Chan for his prolonged victimization by the political movement. In other words, the men were seeking closeness, acceptance and recognition, care and support from their partners.


– Highlight Loc. 4229-36

the blitz union for some of these men and their emotional needs to heal their wounds and sufferings defy the account of using “romantic love” or “companionship marriage” as the norm or model to explain the relationship expectations of them. The romance and mutuality suggested in such accounts are to a large extent compromised by the functional union of these men with their partners and their internal quest for healing of their emotional wound and suffering. Their “romance” lies more with their unilateral, idealistic wish for “family” rather than in the couple’s relationship, and there is certainly little ground for “love” or “companionship” in their rushed, functional union. Instead of romantic love, the idea of “family” appears to be the core value of their relationship development; and instead of mutual care and support, their unmet emotional needs could, at least in the early stage, dominate in the partner relationship.


– Highlight Loc. 4237-55

Although they managed to find their marriage through a “blitz” union or otherwise, these men had endured a great deal of frustrations in their subsequent family development, and there were three main sources of their frustrations. First of all, they were in the past five years impacted by various life events or stresses such as serious health deterioration, unstable jobs or loss of employment owing to their health deterioration or economic downturn, financial loss due to gambling or business failures, death of close family members, being arrested and put on trial, and so on. Secondly, as with all other families, these men had encountered frustrations in managing the family finances, child behavioural problems, and in-law conflicts. Half of the men received or were still receiving public assistance; all of them Wounding and Being Wounded 191 (including TIN) were in the past five years under a great deal of financial stress because of their unstable jobs or loss of employment. In terms of child supervision, three of the men had problems in supervising their children who warranted their special attention; in TIN’s case, his two adolescent daughters were on the verge of delinquency. In terms of in-law conflicts, five of the men (including TIN) reported having conflicts, either between them and their partner’s parents or between their own parents and their partner. Finally, the men were greatly frustrated by the relationship with their partners. It should be noted that their frustrations were not so much directed towards the partner’s household and childcare responsibilities, although many of them did have constant arguments with their respective partners in the latter area. Instead, they were frustrated by the way their partners related to them especially when they were faced with their life events and family problems. In other words, they were frustrated because their partners had violated their expectations of her role in the intimate relationship. In TIN’s case, he felt being treated as an outsider by his wife. Moreover, some men were seriously wounded by their own partner’s provocative response at a time when they were agonized by some personal or family crises: for KEN, his girlfriend used to threaten separation when he was awaiting trial for his sexual offences; for TANG, his wife had used an allegedly bogus extramarital affair to avenge her suffering in the relationship; and for TUNG, his wife refused to attend the funeral of his ninety-year-old mother, thus avenging her hurt at his refusal to attend her father’s funeral many years ago.


– Highlight Loc. 4256-60

The many frustrations were apparently an assault both on the men’s sense of identity and in particular on their reparative wish to fulfill their unmet emotional needs in the intimate relationship. When faced with the many frustrations in their family life, they were confronted with a multitude of emotions which could be intense and overwhelming: sadness, loneliness, fear, anxiety, resentment, dissatisfaction, hopelessness, loss of control, being attacked or wronged, being trapped, being betrayed, being threatened, being neglected, being shamed or humiliated, being rejected, and so on.


– Highlight Loc. 4263-72

my view, the vulnerabilities of these men can be categorized into the following four types or sources. 192 Chung-ming Chan 1. Vulnerability to unhealed emotional wounds from past experiences ― Owing to their miserable personal and family experiences, the men carried heightened and reparative expectations in their intimate relationships and they were easily harmed by re-invoked feelings of the past wounds. 2. Vulnerability to the impact of life and family events ― The various life events in relation to one’s loss of health, employability, money, death, freedom, children’s well-being and so on were certainly an assault to an individual’s self-esteem or identity. 3. Vulnerability to the frustrations in an intimate relationship ― Their partner’s provoking responses in their daily interactions and especially at times of critical situations presented another assault to their self-esteem. 4. Vulnerability to jumbled, overwhelming emotions ― When the emotions arising from the various frustrations were jumbled together, they could be overwhelming and presented a serious challenge to the men’s emotional integrity.


– Highlight Loc. 4283-90

According to the attachment theory (Feeney 1999; Hazan and Shaver 1987; Shaver et al. 1988; Mikulincer et al. 2002), couples in intimate relationships have an internal working model of the relationship and how they expect to be treated. Couples typically expect their partners to be attentive, responsive and supportive especially in times of stress. In handling a negative emotional experience, an individual develops different strategies as a result of past attachment experience and repeated experiences of regulating distress with the partner: handling negative Wounding and Being Wounded 193 feelings in a relatively constructive manner by acknowledging distress and turning to the partner for support (referred as secure attachment); resorting to self-reliance as a way of reducing conflict with the rejecting or insensitive partner (referred as avoidant attachment); heightened awareness and expression of negative feelings as a way of maintaining contact with the inconsistent partner (referred as ambivalent attachment).


– Highlight Loc. 4299-4301

The above analysis suggests that the male batterers were exposed to a number of vulnerabilities or injuries and had difficulties in managing the emergent emotions which at times threatened to overwhelm them. These overwhelming emotions may then fuel their aggression towards their respective partners or explode occasionally into extreme violence towards the partners.


– Highlight Loc. 4302-13

Goldner et al.’s theory rests on the premise that the construction of gender and gender difference is a universal principle of cultural life that manifests itself in the individual psyche, the metaphysical framework, and the ideologies of a society. There is a taboo against the similarity between men and women and the dread of the collapse of gender difference operates silently and powerfully in all relations between men and women. These fears are normatively central to the development of men’s masculinity and they are socialized to be different and stronger than woman, to control and overpower, and to deny their dependency needs and weak, “feminized” feelings. However, in the romantic alliance between a man and a woman, there is an illusion of a collapse of gender 194 Chung-ming Chan differences in their love relationship ― men are allowed to express need or vulnerability without dishonour and women are allowed respect and dignity to their voice. But when the man is pushed to an intolerable feeling of similarity to the woman, he is terrorized by the weak, “feminized” feelings and will reassert his masculine difference and dominance by resorting to violence. Regarding men’s reparative expectations that the intimate relationship might provide healing to their emotional wound and suffering, Goldner et al.’s postulation regarding the men’s illusion about the collapse of gender differences between the couple has gained some support in the men’s cases.


– Highlight Loc. 4319-31

Goldner et al.’s theory. First of all, as discussed earlier, the majority of couples did not develop an intimate relationship based on romantic love. Instead, in their mostly functional union with their partners, it was “family” that played the significant role of tying them together and fostering the couple’s expectations towards each other. Family played a significant role in these men’s self-development such that it became part and parcel of their identity. Secondly, in addition to the four sources of vulnerabilities for these men, Goldner et al.’s postulation points to another type of vulnerability harboured by the men at a deeper, unconscious level ― vulnerability to being similar to women. But important as the role of this gender-based vulnerability in male battering behaviour may be, the role of other more generic vulnerabilities should not be overlooked. More importantly, when they are exposed to life and family events in an intense intimate relationship, how much difference is there between members of the opposite sex? Could there be more similarities than differences? Could there be a wide variation even within members of the same sex? Thirdly and finally, contrary to Goldner et al.’s postulation, some men in this research sample were not in denial about their weak feelings and need for support in front of their partners. Instead, it seemed to be their partners who did not acknowledge or even reject their expressed feelings and emotional needs. Therefore, in my view, as much as there are gender differences in the men and women’s acceptance and expression of their feelings and needs, there are also important differences in how their expressed feelings are accepted or rejected by their partners.


– Highlight Loc. 4342-56

For those men who held explicit and strong patriarchal values, they on the one hand felt justified in asserting domination and control in the relationship and, on the other hand and perhaps more importantly, hinged their emotional comfort upon their wife’s subservience. However, like any other man in the research sample, these patriarchal men were prone to various vulnerabilities in their personal and family development; and their patriarchal domination provided a deadly cover for their vulnerabilities. Contrary to their wish to find emotional comfort in the intimate relationship, their gender superiority beliefs made them more vulnerable in several ways. First of all, when faced with rejection and challenges from their wives, they were susceptible to feeling that their leadership was threatened and themselves being humiliated. Secondly, since their emotional comfort hinged upon the care and subservience of their partners, they were further alienated and wounded at times of confrontation with their partners who could hardly be caring and subservient to them at times of confrontation. Thirdly, when these men were struck by jumbled, overwhelming emotions and therefore came close to their weak, “feminized” feelings such as sadness, inadequacy and shame, the similarity with women posed a great threat to these men who believed that they were superior to women (Goldner et al. 1990). Moreover, in dealing with their emotional frustrations and vulnerable feelings, instead of advancing their self-understanding and self-care, they tended to adopt a moralistic view and focus on the wife’s violation of their relationship virtues (不守婦道、唔識做人老婆), and their 196 Chung-ming Chan patriarchal beliefs provided them a dominant justification to release their anger and other emotions through aggression towards their partners. But their aggression could hardly provide any comfort but only further alienated their wives from them, therefore aggravating the marital conflict and leading to further frustration.


– Highlight Loc. 4362-64

To understand male battering and thus design the appropriate treatment strategies for the male batterers, the findings of the men’s vulnerabilities and emotional injuries in this research study demand us to go beyond the focus on the male batterers’ “violent face” and touch on their “non-violent faces” in the context of their personal and family development.


– Highlight Loc. 4364-73

These men may have a number of vulnerabilities as mentioned earlier ― vulnerability to unhealed emotional wounds from the past experiences, vulnerability to the impact of life and family events, vulnerability to the frustrations in the intimate relationship, vulnerability to jumbled and overwhelming emotions, and vulnerability to being rejected in expressing their “feminized” feelings ― which operate through the men’s developmental experiences in the past, values attached to family, expectations of the intimate relationship, and management of emotional frustrations. Owing to these vulnerabilities, the men may feel being wronged during confrontation and their violent outburst is an attempt to protect themselves from being wounded emotionally by their partners or otherwise. In this act of protection, they are likely to be immersed in their hurtful feelings, seeing themselves as being wounded and justifying their violent reaction as an inevitable self-defense. As a result, it would be difficult for them to look at or experience their behaviour from another angle, that is, the violent and controlling side of their self-protective behaviour as well as reparative expectations in the relationship.


– Highlight Loc. 4377-81

In my view, in order to establish the connection and therefore the basis for intervention with these men, we need to adopt a “both-and” approach: While their aggression is not to be accepted and themselves not to be exonerated from the responsibility, their miserable experiences and resentment should be heard with empathy and with a view to understanding the vulnerabilities that may under-lie their violence. Such empathic understanding may provide not only ventilation of their pent-up emotions but also space for the men to reflect on their own experiences.


– Highlight Loc. 4384-86

The questions are: Which types of anger are particularly prone to violent outbursts? What are the roles of other emotions (such as shame, jealousy, hatred, depression) in contributing to these angry emotions and/or violent outbursts in an intimate relationship? Finally and most importantly, what is an effective, alternative management of these emotions?


– Highlight Loc. 4387-88

Moreover, in relation to the men’s emotions, it was found in this research that certain types of issues may be particularly volatile and hurtful to the men.


– Highlight Loc. 4476-77

Though no group differences were found in the cognitive test performance, patients with subjective memory complaint reported a higher level of anxiety than those without.


– Highlight Loc. 4481-85

post-trauma experiences as an internal event to the person caused by the onset of severe physical illness. The onset of physical illness may be sudden, unexpected and immediately life-threatening like stroke or myocardial infarction. The potential for psychological reactions to these events can be comparable to other traumatic reactions. Post-trauma reactions often include intense feelings of helplessness and high levels of anxiety and uncertainty about the future (Tedstone and Tarrier 2003). It is important to understand these reactions as they can act as a trigger for a range of responses which in turn will affect interventions and rehabilitation (Alonzo 2000).


– Highlight Loc. 4486-90

Severe acute respiratory syndrome (SARS) was the name given to this disease at that time because patients suffering from SARS had flu-like and respiratory symptoms; for example, fever, cough and difficulty in breathing (Donnelly 204 Alma Au, Iris Chan, Patrick Chung-ki Li and Kam-mei Lau et al. 2003; Lee et al. 2003). SARS attacking human lungs has been considered as atypical pneumonia; tomography and chest radiographs of the SARS patients disclosed multiple areas with peripheral ground-glass appearance and consolidation on the lung, causing different degrees of lung injury (Lau et al. 2005). This disease was later found to be caused by a novel coronavirus (SARS CoV) (Peiris, Yuen, Osterhaus, and Stohr 2003).


– Highlight Loc. 4851-53

Although cancer is the major cause of death, these patients also had other comorbid chronic illnesses at the time of death. Cancer, together with other chronic debilitating diseases of the heart, lung, kidney and the neurological system, accounted for half of the deaths in Hong Kong (Tse 2007a).


– Highlight Loc. 4886-87

According to another local qualitative study on thirty-three Chinese palliative care patients by Mak (2001), awareness of dying was identified as the foremost element of a good death.


– Highlight Loc. 4895-4900

When thinking about suffering due to cancer, patients are often overwhelmed by the anticipatory or existing pain, as if pain is the hallmark of cancer. Studies have shown that cancer patients suffer from multiple symptoms in addition to pain. Pain, dyspnoea, fatigue, anorexia, nausea, vomiting, constipation, weight loss, cough, insomnia are among the common ones (Lo et al. 2002). In a local study on advanced cancer patients at the last week of life (Kwok, Tse and Ng 2005), patients reported multiple symptoms and among all, fatigue, cachexia and anorexia were among the most distressing ones. Indeed, these are often regarded as the triad of symptoms in patients who are imminently dying.


– Highlight Loc. 4903-4

The overall distress as experienced by the patient is subjected to his or her own appraisal as affected by multiple internal and external factors. It


– Highlight Loc. 4905

In addressing the distress and suffering from the symptoms, a multidimensional approach is required.


– Highlight Loc. 4908-13

I did not expect his lung lesion to cause any significant pain, and indeed, he rated his pain over the right chest (where his lung tumour was lying in) as very mild in intensity, of grade 1 out of 10 in a numerical rating scale. The pain was also transient, and would subside spontaneously. However, the impact of this “mild” pain actually lasted for a disproportionate duration of at least 4 to 6 hours. Every time the pain occurred, Chong would fantasize about his cancer growing bigger. Instead of carrying out his social activities that he was perfectly able to do so, he would rather be alone at home, perplexing about his cancer.


– Highlight Loc. 4913-15

The suffering of those dying is far beyond that of symptoms or the disease itself. The “disease” itself is not the focus of care, but should be the person living with the illness and dying from the illness.


– Highlight Loc. 4915-17

The idea that humans are dichot-omized into “body” and “mind” (Descartes, 1596–1650), has deep-rooted influence on development of Western medicine. With this dichotomy, the body was left to medicine. We keep on fixing the body, with little awareness of the suffering of the whole person. Helping the dying involves recognizing the patient as whole person.


– Highlight Loc. 4923-26

in the book The Nature of Suffering and the Goals of Medicine (2004), Dr Eric Cassell described a whole person as one consisting of the dimensions of physical body; behavioural pattern; roles and functions; relationship with self, others, and his/her god; past life experience and transcendence.


– Highlight Loc. 4950-52

Ming carried with him a strong sense of aloneness and loneliness as he appeared before our palliative care team. He could feel no one understanding him, as if he was disconnected from this world. The family was so valuable to him, and his act of doing something for his family had given him strength to live.


– Highlight Loc. 4954-55

The Modern Palliative Care Movement The rise of palliative care in medicine is responding to a call for alleviating the suffering of the dying.


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Palliative care, as defined by the World Health Organization (WHO), integrates physical, psychological and social care and provides relief from pain and other distressing symptoms. Palliative care affirms life and regards dying as a natural process; it neither hastens nor postpones death. Patients with life-limiting illnesses are supported to live as actively and fully as possible.


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Instead of the traditional biomedical model adopted in modern medicine, palliative care is characterized by a paradigm shift to the biopsychosocial and spiritual model. In order to relieve suffering, patient should be seen as a whole person, who has own experience of suffering as a spiritual being. Therefore spiritual care is an integral part of palliative care. And therefore in the presence of an incurable illness and a decaying physical body, therapeutic activities are still possible. This is mediated by professionals with skill and knowledge, who can establish a therapeutic relationship with the dying through acceptance and compassion.


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Compassion is not pity and sympathy. Compassion compromises of three active steps (Sulmasy 1997): firstly, to recognize the contents of suffering objectively; secondly, to understand the experience of suffering subjectively; and thirdly, to help the one who suffers by words and deeds actively.


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In one study on advanced cancer patients (McCarthy, Phillips, Zhong, Drew and Lynn 2000), they increasingly preferred not to have CPR and life-extending treatment as they approached death. They would prefer to die than spending time in coma or on ventilator. In one more recent study on 440 patients (Heyland et al. 2006) with advanced cancer and non-cancer illnesses, 55.7% of patients opined that “not to be kept alive on life support when there is little hope for recovery” as an important factor of quality end-of-life care.


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A hospital is never like home. Rules and regulations, routines, and lack of privacy contribute to depersonalization of death and dying.


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Illness is a family matter. While the patient suffers, the family members also undergo a painful journey, which will continue as they grieve after patient’s death. The dying journey is then one of saying goodbye to possessions, achievements, and relationships with the loved ones. While patients are facing the pain and suffering as the diseases progress, the caregivers are continuously adjusting to the burden of care giving. The importance of the palliative home-care service cannot be over-emphasized in this difficult journey. It facilitates continuity of care after patient’s discharge from hospital, and supports patients to stay at home for as long as possible. In delivering a home visit, the palliative home-care service will perform assessment of the patient and family and provide on-site intervention and appropriate bridging and referral if necessary.


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Although dying at home may not be preferred by some patients or families, it is important that home death is an option when so desired.


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A good death is a consolation not just for the dying, but also for the living.


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Care for the dying is not just a family matter, or just a part of the medical care, but also a matter that concerns the society by large.


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As palliative care workers, the encounters with our patients teach us not so much about how to die, but more importantly how to live even when the end is expected to be near. It is the present where we live, not the past, not the future.


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There are four key features in the international disaster management scene: mitigation, preparedness, response and recovery (Coppola 2007). Mitigation refers to the reduction or elimination of the likelihood of disasters. Preparedness refers to readiness of people to cope with the disaster and their chance of survival. Response means actions to reduce or eliminate the impact after the disaster.


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Recovery is about rebuilding and returning victims to the normal state of life.



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As we can see from the UN resolution, while advances have been made in international disaster management in the past decade, there has been little or no reference to post-disaster psychological support. The emphasis is still on saving of lives, replacement of damaged property, and restoration of the economy. Behind this is perhaps the still unresolved conflict among mental health professionals regarding when or if psychological support services should be provided.


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Experience shows that psychological needs permeate and affect all other aspects of relief such as shelter, food and basic health care.


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In the development of psychological services in response to disasters, the consensus is more important than the differences.


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The consensus is a compromise of a kind that seeks to circumvent the debate on what types of specific interventions are useful. It emphasizes the basic principles or philosophies and allows flexibility in the development of specific strategies. This is perhaps the most sensible and pragmatic approach to solve the problem.