15.5 How Should Child and Adolescent Psychiatrists be Culturally Responsive to Child Sexual Abuse (CSA) Including Unwanted Sexual Touching? An Ethnographic Study in Cambodia

Abstract

Prevention of child sexual abuse (CSA), including unwanted sexual touching, is of critical significance, and interventions with culturally diverse groups pose significant challenges to child and adolescent psychiatry. The objective, using Cambodia as a case study, is to provide a framework for a culturally responsive program to prevent CSA. Fieldwork between 2014 and 2021 involved 380 informants: 1) child abuse generally, 86 relatives of abused children, 62 Buddhist monks and officiants; 2) abuse by monks, 196 informants (104 female, 92 male); and 3) genital touching, 36 informants (22 female, 14 male). We were guided by United Nations Children’s Emergency Fund (UNICEF) Ethical Research Involving Children (ERIC) criteria. We explored cultural constructions of all forms of CSA and how people reconciled their ideas with those brought by Western mental health professionals. Through content analysis, we noted the cultural registers and the use of popular cultural references. There were at least 150 defined cases of sexual abuse across the 3 groups, mainly in the first 2 groups. Most informants viewed CSA as stemming from “cultural attractors,” including blighted endowment from a previous life, a bad character, astrological vulnerability to abuse, preordained entanglement between the child and the abuser (they are “fated” to meet), sexual craving, “entering the road to ruin,” and a moral blindness that portrays the abuser as blameless. CSA prevention programs in developing countries often strive to change the local cultural values through education. We argue that a better strategy is to leverage—rather than eradicate—these beliefs to overcome misbeliefs about CSA including unwanted sexual touching. The findings provide a template to enable child and adolescent psychiatrists, working with police, counselors, educators, and rights-based organizations, to provide better services to those affected by CSA. There are implications for child and adolescent psychiatrists working with immigrants who resettle in Western countries.