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New York: Guilford Publications ; bill. Bullying as a group process: Participant roles and Aggress Behav ]. Psychosocial determinants 3. I will discuss the salient metaphors and common sense notions of this community as they appear throughout survivor websites that have sur- faced to meet the needs of a community support group existing in cyberspace. This evolution of the survivor narrative from an oral act to a written act to a virtual act creates a space for new ideas about the discourses of healing that have only begun to be considered and dis- cussed.
The concept of "intertextuality," reminds us that the virtual journal exists as piece of a larger whole: a narrative posted on a website that exists on the World Wide Web Berkenkotter After I examine the various survivor websites, I will analyze the virtual journal from a virtual support community for survivors using entries from Healthy Place.
Janice Haaken reminds us that psychoanalytical approaches to trauma often privilege narrative over memory, stating that "in contradistinction to much of cognitive psychology, which stresses the mechanisms of memory, psychoanalysis asserts a narrative coherence to mental life" Pillar Maintaining this focus on the role ofnarrative and the activity of transformative remembering, rather that on memory, allows us to understand how language is utilized to create coherence in psychic life.
In analyzing narratives of child sexual abuse survivors, I find The Life Story model presented by Charlotte Linde to be useful in understanding the importance of this written form of healing within this community. As Michael Toolan indicates, it is the change in affairs-the personal change in the narrator-that renders survivor narratives "tellable": At minimum [a narrative is] a text or text-like artistic production in which the reader or addressee perceives a significant change.
In a narrative, something happens, such that we sense a state ofaffairs, and this latter state is, ideally, not merely temporally but causally related to the former state.
This need for a coherent life story for survivors of trauma to "re-create the flow" oftheir life and to re-create a stable sense of selfis also encouraged in the field of psychiatry Herman. Narrative is a significant resource for creating our internal, private sense of self and is all the more a major resource for conveying that self to and negotiating that self with others" In understanding how identity is created through narrative, Linde established "maj or characteristics ofselfthat are specifically maintained and exchanged through language.
The second characteristic, "relation of the self to others" is achieved through linguistically marking the narrator as sepa- rate from others, by use of names and pronouns. The final element, "reflexivity of self' is accomplished by the act of telling a story about one's selfin the past, while actively editing and reshaping the tale while in the present Linde's approach points to the characteristics present in narratives that allow a person to create themselves through the process of telling their tale of self.
Through the process ofnarration, the individual weaves a self, either similar, but slightly evolved, or com- pletely different from, the self that began the telling. This story will continue to evolve and change as the narrator continues to grow and retell the life story.
This evolution of the narrator is the heart of why these narratives are tellable, allowing survivors of child sexual abuse an avenue to express themselves-and affirm for themselves-that they were abused in the past, but the past does not need to continue to haunt their lives forever.
Sonia Apgar agrees that re living the experience through language is necessary: "One ofthe major components of the recovery process is the establishment of a coherent personal narrative that not only fits with the survivor's memo- ries and perceptions, but also fits into the social constructions or cultural norms available to her" It is the re creation of self-one that is no longer a victim- that makes survivor narrators healing and beneficial. Although Linde defines the life story primarily as an oral form, I find her framework helpful in an analysis ofvirtualjournals.
Linde notes that, in its construction of the social self, the genre of written autobiog- raphy is the most similar form of the life story. And although the genre is written, it appropriates both oral and written discursive practices simultaneously. Internet users do not follow the traditional norms, such as formal language and syntax that characterizes much language.
Instead, rhetors tend to write online as if they were speaking rather than writing to their virtual audience. Another parallel between virtual journals and life stories is the presence of self-evaluation. This is ofprimary importance with survivor narratives, especially for narrators who feel it is part oftheir goal to create public awareness. In these narratives, events of the abuse become the reason for telling and sharing personal journal entries.
The structure of the virtual j oumal as an arena to tell and retell-as entries are added at later dates-fills the final requirement for the life story of "extended reportability. Linde points to an unfortunate lack ofhistorical examinations ofraw data from genres such as diaries, letters,j oumals, and popularj oumalism. In this study, I intend to respond to this lack of research, beginning with a historical examination of the healing journal and its place within the discourses of healing.
Evolution of the Discourse of Healing Prior to , the discourses of healing through telling were not the dominant discourses in American society, nor was the topic of child sexual abuse. I argue that due to an ideological shift-brought about by the government's enactment of the Child Abuse Prevention and Treat- ment Act that was passed in a social space was opened for a dialogue about this issue that did not previously exist in American society, followed by a dialogue about telling to heal.
This social event created what Carolyn Miller calls "motive" "Genre" With this new socially constructed definition ofabuse, a community of victims also emerged; even though these victims had always existed, they were not previously recognized as such.
Though the concept of a victim was not new, the perception of people as victims of childhood sexual abuse was. In order to make sense ofthis new category of victims, people applied their previous understanding ofwhat victims were in order to understand the trauma that this newly constructed community spoke of. Schutz and Luckmann remind us that this transferring of the familiar categories in this case of "victims" constructs the perception of the genre and how to function within it, by stating that "Whatever is typically relevant for the individual was for the most part already typically relevant for his predecessors and has consequently deposited its semantic equiva- lent in the language" This connection semantically creates these victims in a new light as society applies its previous understanding of victims to this emerging community.
This kind of transferal is relevant also to the self-definition ofcommunity members as survivors rather than victims, further illustrating how the semantic lens filters how we per- ceive-and thereby define-people and rhetorical situations. This new community of survivors created a social space in their need for programs to assist them in healing from their trauma.
As a result, a space opened up for the emergence of support groups, counselors and self-help books that catered to helping the victim heal. Out of this discourse ofhealing another ideological shift took place, from which the discourse of telling emerged somewhere between the mids and the early s. Fairclough shows us that ideology "ways ofseeing" and the discursive processes "ways of talking" are enmeshed in what he calls "ideological-discursive formations. Therefore, the increase of survivors telling their stories publicly represents and re creates the discourse of telling as accepted and naturalized within American society at this time.
With the emergence of the discourse of telling, many survivors turned to journal writing-an already existing genre. In the early s, as part of the greater goal to stop abuse by talking about it rather than allowing it to fester in the silence in which it thrives, survivor journals were moved into the public forum. This previously private medium became one ofthe vehicles for public discussion about the issues surrounding childhood sexual abuse trans- porting survivor narratives of trauma and recovery to the public.
Many journals were published in anthologies, autobiographies, and other forms such as poetry and vignettes in self-help books. These narratives may be in the form of survivor stories-which are a one-time telling of the traumatic events as remembered by the survivor, or as a healingjournal- which functions as an ongoing story, with the traumatic events often woven throughout the journal strand in a number of entries. Cyberspace: A Place for Healing Websites as a place for healing are an ever increasing trend, as they offer a locatableplace for survivors to tum to find help and support during their healing process.
I have found three basic types of sites, each providing different degrees of support to the survivors. The most complete type is the virtual community, followed by resource sites and individual pages respectively.
Virtual communities offer the widest array of services and resources to the survivor and create a sense of connection that can only be rivaled by a non-virtual community support group. These sites are often moder- ated-policing users" and content that may have a triggering effect I7- in order to maintain a safe space for survivors. This naming has the power to create a greater sense of involvement and participation on the part of the visitors to the site. This less explicit approach tells survivors that they have returned- as if going home, rather than going to a new and less familiar place.
HP also uses the home page as a bulletin board to keep members informed. It visually resembles a newspaper, with resources and links along the left side of the page and events for that week-complete with a few para- graphs of description-forming two columns in the center. The use of family and community by website designers can be viewed as determin- istic in the way it creates survivors as family members in these virtual communities, along with constructing itself as a familial place.
Resource sites are personal websites that put information out, but also take a limited amount of information in. Resource sites generally have a mix of the same things offered by the virtual community, although they do not interact with members to the degree that the virtual community sites do.
Resource sites allow survivors a place to go to find help and know they are not alone, while maintaining some type of interactive medium such as a chat room or newsgroup. Have Survived are two sites that fall into this category of resource sites. I Have Survived is another resource site that has not been named as a place and subtly announces the agency ofthe web designer.
This page does not claim the name of the page as does Susan, but as I, guiding the reader to the experience ofthe designer ofthe page. Individual pages are the most basic in services offered, in that their sole purpose is to put information out.
They do not seem to interact in the same way as the previous two groups. The home pages seem to be operating as the bulletin board in which the web designers hang their mission statement for users to read. Teddy Bear 's Secret states, "Our purpose is to expose some of the harsh realities which continue everyday. We share our stories of abuse to create a better understanding of the pain caused and create an outlet for any of you who have not yet been able to tell.
We are not here to judge, but to heal. But to tell it quietly. And to help others if only by sharing. I want it to be known that childhood sexual abuse still exists Perhaps this will be my journal in cyberspace. If it helps others, that would be wonderful. Ifnot, well, at least I tried. Individual page design- ers do not generally name their sites as a communal place for others, but instead use names that metaphorically represent their own experience, as these sites closelyresemble a personaljournal with links to other sites and resources to help others.
The individual pages-Enlergence, This Child's Journey and Teddy Bear's Secret-follow the patterns found for virtual journal titles and use common metaphors of abuse and healing, as will be discussed later.
These concepts function within this discourse community as what Foucault would call their "regime of truth": the types of discourse that it accepts and makes function as true Power. Linde refers to these truths as "common sense" notions within discourse communities The move from one common sense belief system is seen to be an abrupt change, as one system remains in play for "fairly long stable periods" until that system is either "entirely reversed or abandoned in favor of a new formulation" Prevalent common sense notions that circulate in the survivor discourse community include the belief in the wrongfulness of child sexual abuse as perpetuated against the survivor and the importance of telling about the trauma in order to find emotional healing.
Following this threadoffaultand blame is the common sense notion that child sexual abuse is wrong and that it is not the survivor's fault, despite the fact that she may feel that it is.
In one ofher entries, Kristina makes the claim that she is not at fault: "I have done nothing wrong. This verbal display ofa common sense notion is an empowering speech act for survivors. Another notion that is evident in survivor texts is the concept of accessing the little girl inside survivors as an integral part of recovery work for survivors in this community.
The theory is that until the survivor recognizes the part of themselves that was hurt-which is a piece of themselves that was stunted at the age of abuse and is still in pain-they will be unable to heal.
Survivors, such as Kristina refer to their little girl when participating in the discourses ofhealing. Another thread found throughout narratives is the idea that survivors are fragmented and must work through recovery to become whole.
Amy's journal introduction talks about "the struggles to become whole. The trauma ofsexual abuse is always with the survivor and permeates her life always; regardless of her attempts at healing and recovery Bass and Davis; Bass, Thornton and Brister; Brison; Herman.
Support group facilitator Ann Gauling tells survivors at their first meeting, "You will never be the same. But you can be better" Brison Brison emphasizes the fact that survivors have the ability to be better through recovery work, despite the lifelong effects of trauma. This notion is reflected by the changing discursivity from survivor stories to survivor journals. The structure of survivor stories as a onetime telling reflects an ideology that is representative of the early discourse ofhealing, which valued the mere act of telling in order to heal.
The current shift in ideology has built upon the earlier while adding an element of continuous engagement in the discourse, as the genre of the continuous journal reflects. We see this ideal reflected by both survivors and psychiatrist. Where many people on the outside ofthe community do not subscribe to the same common sense notions as survivors is the idea that speaking out is necessary for social change. Due to the difficult nature ofthe topic, many would rather not speak of such atrocities; therefore, they do not engage in the discourse of telling, but rather prefer the discourse of silence.
That this common sense notion is not inversely shared indicates that within the survivor community it is what Linde refers to as a "coherence system": a discursive practice that represents a system of beliefs and relations between beliefs In fact, the case can be made that recovering survivors are in fact experts within this community discourse and therefore are applying expert systems to their discourse as opposed to using common sense.
A more logical conclusion would be to think of notions that are foreign to community outsiders as common sense within the survivor community only, or possibly as coherence systems that will soon evolve into common sense notions to a large social community as the discourses of healing permeates a greater community and become more pervasive in non-survivor communities.
Metaphors and Ideologies in the Discourse of Healing The metaphors that fill virtual journals and survivor sites revolve around ideas of"healing as ajourney" and "a transformational process," as well as metaphors of "bodily injury as a representation of emotional injury.
Ifone were to graph the healingjourney ofa survivor through following theirjournals for an extended period oftime, the journey would not resemble a direct linear progression up the hill-with injury being at the bottom and wellness being the destination at the top of the hill-but rather a trek through rugged mountainous terrain. The trek would be filled with long strenuous hikes up hill filled with difficult lessons of learning and growth , moments ofplateaus signaled by moments of insights and calmness , short descents signaled by moments of falling back into old patterns ofthinking or remembering pain , and a continued striving back up the hill toward the destination of well ness.
This metaphoric represen- tation ofhealing as ajourney is visible throughout virtual j ournals within both the titles and texts. Ofthe five titles on the HP site, as shown in Figure 1, four ofthem use the journey metaphor in their titIe or subtitle.
The one writer who does not utilize the journey metaphor turns to injury, another common metaphor. Enquiry about the causes of the swelling provided unclear answers. Family history indicated that the young boy was a first-born among three siblings 9-year-old girl, 5-year-old boy , and that their single parent mother had been deceased for 6 years due to HIV-related complications.
The three children had moved to live with their maternal grandparents and their seven sons. The patient had no adverse past medical history and had never consulted a dentist previous to the present problem. The boy was in grade seven in a local primary school and had the aspiration of becoming a medical doctor in future. It was not possible to establish from the aunt or the boy the situation of the patient's other siblings.
An extra-oral examination showed a young boy with a normal gait, sickly, unkempt, rather withdrawn, and small for his age. He had asymmetrical face due to the swelling involving his left submandibular region and spreading upwards to the inferior orbital margin, febrile However, the temporomandibular joint movements were normal.
The patient was also found to have a big, healing scar on the dorsal surface of the left foot, the cause of which was also unclear [ Figure 1 ]. Intra-oral examination revealed a young boy in the permanent dentition with un-erupted third permanent molars, poor oral hygiene with heavy plaque deposits on the tongue and a generalized but moderate inflammation of the gingiva.
There was a grade three mobility in relation to 11, 12, 21, 22 and a grade two mobility in relation to 23, 24, 25 Miller mobility index. On elevation of the upper lip, active discharge of pus mixed with blood and some black granules could be seen emanating from the abscess.
Orthodontic evaluation showed Angles class I molar relation on the left and edge to edge tending to class II on the right side. The canines were in class I relationship bilaterally. For investigations, orthopantogram, intra-oral periapical 11, 12, upper and lower standard occlusal and bite wing radiographs were taken and examined.
In addition, clinical photographs, study models, and vitality tests for the traumatized teeth were undertaken. A diet and nutrition assessment, full blood count, stool microscopic analysis for ova and cyst and bacterial culture and sensitivity were also undertaken.
The results of the radiographs showed un-erupted with potential impaction of 48 and 38, an upper midline radioluscence, widened periodontal space in relation to 11, 21 with a mesial tilt , 22, occlusal caries on 46 and buccal caries on 47 and There was the presence of root fractures involving the apical one-third of 21, Vitality tests conducted on the traumatized incisors showed false positive may be due to the presence of infection.
The blood analysis showed the presence of neutrophilia suggestive of bacterial infection , mild iron deficiency, but he was sero-negative. From the diet chart, the boy was generally on a noncariogenic diet that lacked the intake of fruits and animal proteins. Nutritional assessment revealed a boy with a height of cm, a weight of 28 kg, and a body mass index BMI of From the history adduced and the results of the investigations, a diagnosis of child abuse and neglect was reached, with the boy having suffered traumatic injuries resulting in facial cellulitis, Ellis class VI fracture involving 21, 22 associated dentoalveolar abscess and subluxation of 11, In addition, there were dental carious lesions on 46 occlusally , 47 and 37 buccally and a relatively severe malnutrition.
The patient had also moderate plaque induced gingivitis, mild anemia microcytic and iron deficiency , mild dental fluorosis, potentially impacted 48 and 38 and crowding in the upper right and lower anterior arches. The objective of treating the boy was to eliminate the pain, infection, improve the general and oral health, restore carious teeth, improve esthetic and report the child abuse and neglect to the relevant authorities. In the initial phase of treatment, the patient was admitted for 4 days and placed on dexamethasone 8 mg stat, cefuroxime mg 3 times a day, metronidazole mg 3 times a day, diclofenac 50 mg tablets alternating 4 hourly with oral paracetamol mg 3 times a day, to run for 5 days.
Patient was also placed on chlorhexidine mouthwash 10 ml twice daily for 7 days and ranferon hematinics 10 ml to be used twice a day for 1 month. The second phase of treatment included incision and drainage of the abscess, followed by the splinting of the mobile teeth in the upper dental arch using semi-rigid splint of 0. Root canal treatment of 11, 21, 12, and 22 followed thereafter. The third phase of treatment involved interceptive orthodontics with the extraction of 15 to relieve the crowding in the area.
Oral hygiene instructions were availed to the patient and the guardian, placement of fissure sealants was done for the premolars and molars to help reduce plaque retention on these teeth, preventive resin restorations were placed on 37, 46, and The root fractures involving the apical one-third of 21 and 22 meant that the two teeth were to be initially dressed using non setting calcium hydroxide, and after healing, root canals are filled in the usual manner [ Figure 3 ].
Postobturation intraoral periapial radiograph showing the restoration on 12, 11, 21, and Nutrition evaluation had initially been done and when the patient was re-evaluated after 1 month, he had gained bodyweight up to 1 kg. The child support center continued to carry out psychotherapy, and during one of the sessions, the patient confessed to having undergone physical abuse and threatened not to divulge any information by one of the uncles.
The center considered placing the boy into a children's home, probably together with his siblings. Radiographic examinations evaluation after 3 months indicated some external apical root resorption taking place on 21 and Further follows-ups were to continue. Posttreatment photographs taken after 10 months showing improved oral health of the patient and the glimmer of confidence in the patient as shown in a-d respectively. All types of child abuse and neglect leave the affected child with long-lasting scars that may be physical or psychological, but they are the emotional scars that leave the child with life-long effects, damage to the child's sense of self, the ability to build healthy relationships and function at home, work or school.
This situation can in turn result in the child turning to alcohol or drugs to numb the painful feelings. On the other hand, the exposure by the child to violence during childhood can increase vulnerability of that child to mental and physical health problems like anxiety disorder, depression, etc. A neglected and abused child like the one described here, can become helpless and passive, displaying less affect to anything whether positive or negative in his or her encounters.
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