Same culture that frowns upon sex-ed, also allows Children to get abused secretively -Dr. Ginige

• Yes, porn can help in releasing stress and enjoying sexuality in the case where there are no partners, or the partner not being available in real life
• However, there are many people, including adolescents and children, with highly plastic brains who find they are compulsively using high-speed internet porn with their tastes becoming out of sync with their real-life sexuality

Sex. As much as it is a taboo word in the conservative, conventional context, this very taboo has also made it a topic of discussion. Recently, society reacted diversely when ‘Hathe Ape Potha’ - an attempt to shed light on sex education - was planned to be distributed among grade 7 students. Issues that the youth have to face due to deficiencies of sex education include everything from being not harassed in public transport or roads, to teenage pregnancies to unsafe abortions, sexually transmitted diseases such as HIV, discrimination on the basis of gender or sexual orientation which would eventually hinder their 

normal psycho-sexual development. According to a research paper titled ‘Characteristics of children who have been sexually abused, incidents of abuse and perpetrators : A study from a tertiary care clinic sample in Central Sri Lanka’ the alleged perpetrator was known to the child in 94 percent of the cases, and this is in par with worldwide data that dispels the myth that children are sexually abused by strangers in dark alleys. In a candid interview with Daily Mirror, the key author of the study, Dr. Pabasari Ginige, Head and Senior Lecturer at the Department of Psychiatry, University of Peradeniya, shed light on certain grey areas related to sexuality and sex education in Sri Lanka.   

Excerpts :  

Q Your study shows that there’s poor communication between parents and children, thereby isolating the child and allowing him or her to keep the experience of abuse to themselves. How could this parent-child connection be strengthened?   

Our study analyses a specific sample of children who are sexually abused and the results cannot be generalised to the general population of the country. However from my experience as a psychiatrist for more than a decade, I can say the results of our local study reasonably reflect the situation in our country. Parents are not comfortable talking to kids about sexuality. That is because they themselves have never had a proper sexual education. They do not know that they should talk to kids about these matters in the first place. When children ask a random question out of curiosity even, the parents shy away and distract the children or just shut them up by saying something like - “oyata owa danma wadak naa” (you don’t need to know such things right now). Therefore, we need a system of giving education to parents on at least the basic facts of human sexuality, and guide them as to how, when and what to talk to their kids about. When parents are comfortable to open a dialogue on sexual themes, the children would also be more relaxed and confident to talk about them with their parents.   

Q  In 94 percent of the cases, children are abused by someone known to them. How does sex education help in this scenario?   

Worldwide studies have come up with this same result. Our analysis also confirms the same. A known adult in a child’s life is the perpetrator in most cases. According to my experience as a clinician, some children were abused by the priest of the village temple or the pirivena, the moulavi of a mosque, the priest of a seminary, the principal or the teacher, the local politician, the grandfather and even the own father. On one hand, the child needs to develop strong bonds with the adults in his/her life. And on the other hand, trusted adults themselves are found to be abusing them more than some stranger. We must be careful in educating the children to protect themselves in this regard. It is not healthy to scare them saying the most loved uncle, granddad or even father would be touching them badly, and yet it is also important to let them know they need to protect themselves from unwanted physical contacts by anybody. This is a hard task, and we have to balance the two aspects sensitively or else more harm will be done than good. That is why only trained professionals should be involved in planning sex education in a country.   

Q It was also found that most children had some level of anxiety and depression in them. But children are seldom brought to psychologists or psychiatrists unless they have challenging symptoms such as self-harm or aggressive behaviour in the class room etc. Doesn’t this show a lack of awareness among parents with regard to the psychology of a child?   

Children who are abused, or even attempted at being abused, naturally have some psychological disturbances. After a major abuse, of course, the gynaecologists or the paediatricians would refer the child for a mental health assessment. But as you have picked correctly, it is not a common practice to bring children with fears and sadness to psychiatrists, although we have just over 100 psychiatrists spread across the country. Qualified psychologists are rare in Sri Lanka. This situation is not specific to sexually-abused children, but is general to all the kids who experience depressive and anxiety features. Adults also hesitate to come to a psychiatrist due to many myths and stigma around mental health. You can imagine the reluctance in bringing children to us. Even when one parent recognizes the need the other would say “lamayata nikan pissu hadawan nathuwa inna” (don’t just cause madness in the child). Actually this is a reflection of the poor mental health literacy in the country.   

Q Other than government interventions, what more could be done to spread awareness among the public, especially in rural areas, to keep vulnerable segments from being abused?   

Sex education may not simply be plugged into the school curriculum. Therefore, to design a culturally appropriate, comprehensive and effective sex education, attitudes and concerns of youth, parents, spiritual leaders and society as a whole need to be explored and taken into consideration. A multi-sectoral approach with all the stakeholders such as specialists in the field such as psychiatrists, paediatricians, community physicians, gyanecologists, probation officers, parents, abused children and adolescents, authorities from the ministries of health and education being represented is what we need. This kind of sex education programme has to be implemented at national level. You may wonder whether it is necessary to listen to children and adolescents in developing preventive programmes. Let me give you an example to give the adults some thoughts on children’s perspectives too in the process. I saw a 10-year-old boy who was sexually abused by the principal of his school for 3 years, the abuse started when he was seven years-old. In the assessment, I asked him a question as to which allows us to explore the thinking in children, “If you get Aladdin’s magic lamp what would you ask from the genie of the lamp?” The child did not waste even a second in replying me “Aluth jeewithayak!” (a new life), and mind you, he was only 10!   

I took part in an awareness raising intervention done by then Director Ampara Base Hospital, Dr. Lanka Jayasinghe and Consultant Paediatrician Dr. Nishadi Ranasinghe in 2011. It was a docu-drama named “Hiru dutu wana mal” produced by private funds of the professional duo to educate children and parents plus teachers about detecting high-risk situations and preventing child sex abuse. I acted the role of a child psychiatrist! The docu-drama also included a comprehensive outline of what should be done if a child abuse case is reported to health care. It was filmed at Ampara where child sex abuse was reported high at the time, and it was widely screened at schools, village halls and relevant local administrative offices such as probation, divisional secretariats etc in Ampara. The clinician colleagues reported the docu-drama was well received by the public, and they found some control in sex abuse incidences, and increased reporting of such incidences too as we expected of course. I believe carefully prepared and culturally sensitive national level awareness-raising campaigns are needed. We can use the already-prepared docu-drama as a pilot study to explore the effectiveness of such tools as educational material. The relevant government authorities should use media to propagate sex abuse prevention rather than spending tax payers’ money lavishly on advertisements on their own party propaganda.   

We need national-level research to see the extent and the depth of the problem in the country. There are a few small scale studies other than the Peradeniya study done on child sex abuse in clinic settings, and there are about two local community studies. But we need countrywide studies. I am looking forward to embark on such a study that will give insights into the problem nationally with a view to have better informed policies on management and preventive strategies for our country.   

• Parents do not know how to talk to their children about sex   
• It is not a common practice to bring children with fears and sadness to psychiatrists   
• Sri Lanka had a rich culture of sexuality before the Victorian era   
• It is advisable for teens not to get addicted to porn   
• Perpetrators are known to the child in 94 percent of sex abuse cases   

Q From the perpetrators’ point of view, why have we become a sexually frustrated society? Is it because we tend to keep intimate relationships and thoughts to ourselves?   

There are several factors that increase a man’s risk of committing sexual violence. Some are individual factors such as alcohol and drug use, antisocial personality tendencies, a history of sexual abuse as a child etc. There are community or societal factors as well. Poverty, general tolerance of sexual assault within the community, weak community sanctions against perpetrators of sexual violence. Some societal norms could be supportive of sexual violence. Some societies believe in and are supportive of male superiority and sexual entitlement. Weak laws and policies related to sexual violence and gender equality favours high risk of violence by men. Let us not forget we live in a country where some people minimize the husband beating the wife to a “parak gahala hari hada ganna epaya” (need to punish to correct her) thinking.   

Sri Lanka had a rich culture of sexuality before the Victorian era where stringent views and attitudes of sex were introduced to and cultivated in Sri Lanka. Our big neighbour India, with its rich sexual culture influenced our culture through the many invasions and exchanges between the two countries over the centuries. Later on the Victorian church influence outsmarted the liberal, more open sexual practices of our culture. The “Eka geyi kaama” for example was considered the norm in some sub-cultures in the olden days in Sri Lanka.   

Q Does watching porn help in releasing these emotions and sexual frustrations?   

Porn is watched by people all over the world. Some people can watch porn occasionally and not suffer significant side effects. Yes, porn can help in releasing stress and enjoying sexuality in the case where there are no partners, or the partner not being available in real life. However, there are many people, including adolescents and children, with highly plastic brains who find they are compulsively using high-speed internet porn with their tastes becoming out of sync with their real-life sexuality.   

There are many studies to claim internet porn addiction can lead to sexual dysfunctions and relationship difficulties and failure. In the first study on internet porn users, which was conducted at the Max Planck Institute for Human Development in Berlin, it was found that the hours and years of porn use were correlated with decreased grey matter in regions of the brain associated with reward sensitivity, as well as reduced responsiveness to erotic, still photos. Less grey matter means less dopamine (the happy chemical) and fewer dopamine receptors. It is hypothesized that “regular consumption of porn more or less wears out your reward system.”   

The growing brains have a higher risk of getting addicted to any addictive substance or behaviour. Therefore, it is advisable for the teens not to get addicted to porn. For adults in relationships to enhance their sexual experience pornography can be used therapeutically and as an educational material, however in controlled doses. It is up to the individual couples or individuals to use porn for their satisfaction. However, it is advisable to know the pros and cons and to have respect for the partner’s preferences in relation to watching porn within a relationship.   

Q Another point that was raised in the earlier article was that teachers are shy to teach these topics to students. What are your thoughts?   

I am sure there is an occasional teacher who does the job right and educates children on sexuality as warranted in the syllabus. Yet unfortunately, I have come across many instances of the teacher skipping the sex education chapter in the syllabus. According to the syllabus, only children above 13 years are supposed to be given sexual education, which is way too late in my opinion. This view is shared by professionals working with children in the global context as well. Even despite that, teachers shy away most of the time without teaching students the basics on human sexuality. The main reason is they themselves never had any proper sex education, and the word “sex” is very much associated with grave stigma. Sex is not a bad thing. If not for it, none of us would be here.   

In my analysis of the sexually-abused children presented to the tertiary care centre at Peradeniya, 9.6 percent of kids were under six years. Compared to developed countries, Sri Lanka is far behind in giving sex education to children according to their psycho-sexual development. The ill-informed sectors get agitated, claiming sex education destroys our culture and the purity of an innocent child’s mind. However, the same culture lets children be abused secretively by some religious clergymen from all religions, politicians and celebrities in more powerful places. The Pan American Health Organization and WHO in collaboration with the World Association for Sexology (WAS) compiled an overview of sexual concerns and problems that should be addressed in order to advance sexual health (PAHO/WHO 2000). It says, “in order to succeed at improving sexual health the community itself should reflect upon and agrees to change its traditions”.   

Q What’s your take on ‘Hathe Ape Potha’?   

The book was compiled by a group of community physicians mainly. They have apparently followed available guidelines in the process. It was given as an additional reading book to the grade 7 age group of school children. At a Parliamentary Oversight Committee that was held recently, in which I was an invited participant, it was established the book falls in line with the recommended syllabus of the students of the said age group. In my opinion it is a great start. Technically the facts are all correct. Some have grave concerns from their point of view that some wording can be improved to go along with our culture. Yes, we have to be culturally sensitive. But if the culture demands not to talk about ‘suda yaama’ (vaginitis), and the young girls of that culture come to seek medical advice for that normal physiological condition even in the second decade of the new millennium, my take is that culture should evolve to a sensible, logical and scientific minded culture.   

Q What’s your message to the youth and vulnerable segments of society?   

All adults are not bad and are not there to touch you inappropriately and even hurt you physically and psychologically by violating your bodies. Yet there may be an adult who is doing all the same. It is important to know how to recognize them and protect yourselves from such people. It is your right. It is also your right to know why certain changes in your body happen. It is again your right to know whether some of your feelings towards the opposite or same sex is wrong or not, and whether it is okay or not to touch your genitals if you have an urge. Do not be shy to inquire from doctors, teachers and parents. If they do not answer, there are educational websites in some major developed countries for teens to educate themselves on sexual matters. Refer those educational websites. Be informed, and do not suffer silently. You are the new generation. Be smart, learn and stay safe!