Similar scenarios have been reported by other intersexuals (Holmes, 1994; Sandberg, 1995-6; Batz, 1996; Beck, 1997). Like CSA, repeated medical examinations follow a pattern which Lenore Terr calls Type II traumas: those that follow long-standing and repeated events. "The first such event, of course, creates surprise. But the subsequent unfolding of horrors creates a sense of anticipation. Massive attempts to protect the psyche and to preserve the self are put into gear... Children who have been victims of extended periods of terror come to learn that the stressful events will be repeated." (cited in Freyd, 1996, p. 15-16). Freyd (1996) proposes that "psychological torment caused by emotionally sadistic and invasive treatment or gross emotional neglect may be as destructive as other forms of abuse" (p. 133). Schooler (in press) noted that his subjects experienced their abuse as shameful, and suggests that shame may be a key factor in forgetting sexual abuse. "The possible role of shame in causing disturbing memories to be reduced in accessibility... might well resemble those sometimes proposed to be involved in repression" (p. 284). David, an adult intersexual, states "We are sexually traumatized in dramatically painful and terrifying ways and kept silent about it by the shame and fear of our families and society" (David, 1995-6). Most intersexuals are prevented by shame and stigma from discussing their condition with anyone, even members of their own family (ISNA, 1995). This enforced silence is likely to be a factor in how their memories of these events are understood and encoded.

Secrecy and Silence

Several theorists have postulated that secrecy and silence lead to the child's inability to encode the abuse events. Freyd (1996) suggests that memory for never-discussed events may be qualitatively different from memory for those that are, and Fivush (in press) notes that "When there is no narrative framework... this may well change children's understanding and organization of the experience, and ultimately their ability to provide a detailed and coherent account" (p. 54). Silence may not impede the formation of the initial memory, but lack of discussion may lead to decay of the memory or failure to incorporate the information into the individual's autobiographical knowledge of self (Nelson, 1993, cited in Freyd, 1996).

When a child suffers a trauma, many parents attempt to prevent the child from focusing on it in hopes that this will minimize the impact of the event. Some children are actively told to forget the trauma; others are simply not given room to voice their experiences. This dynamic operates especially forcefully in the case of intersexed children (Malin, 1995-6). "Never mind, just don't think about it" was the advice of the few people to whom I spoke of it, including two female therapists," states Cheryl Chase. Her parents' only communication with her regarding her intersex status was to tell her that her clitoris had been enlarged, and so it had to be removed. "Now everything is fine. But don't ever tell this to anyone else," they said (Chase, 1997). Linda Hunt Anton (1995) notes that parents "cope by not talking about "it", hoping to lessen the trauma for [the child]. Just the opposite happens. The girl may conclude from the adults' silence that the subject is taboo, too terrible to talk about, and so she refrains from sharing her feelings and concerns" (p. 2). Both Malmquist (1986) and Shopper have put similar views forth (1995), noting that a child may view the adults' silence as an explicit demand for his or her own silence. Slipjer (1994) noted that parents were reluctant to bring their intersexed children to outpatient check-ups because the hospital served as a reminder of the syndrome they were trying to forget (p. 15).

Money (1986) reports cases in which "the hermaphroditic child was treated differently than a sexually normal child, in such a way as to signify that she was special, different, or freakish -- for example, by keeping the child at home and forbidding her to play with neighborhood children, placing a veto on communications about the hermaphroditic condition, and telling children in the family to lie or be evasive about the reasons for travelling long-distance for clinic visits" (p. 168). The Intersex Society of North America (ISNA), a peer support and advocacy group for intersexuals, notes that "This "conspiracy of silence" ... in fact exacerbates the predicament of the intersexual adolescent or young adult who knows that s/he is different, whose genitals have often been mutilated by "reconstructive" surgery, whose sexual functioning has been severely impaired, and whose treatment history has made clear that acknowledgement or discussion of [his or her] intersexuality violates a cultural and a family taboo" (ISNA, 1995).

Benedek (1985) notes that even therapists may fail to ask about traumatic events. The victim of trauma may view this as a statement by the therapist that these issues are not safe topics for discussion or that the therapist does not want to hear about them. She suggests that retelling and replaying stories is one way for the victim to gain mastery over the experience and to incorporate it (p. 11). Given the infrequency of such discussions, it is not surprising that both CSA victims and intersexuals often experience negative psychological sequelae as a consequence of their experiences.

Misinformation

Alternatively, the abuser's reframing of reality ("this is just a game", "you really want this to happen", "I'm doing this to help you") may lead to the child's lack of comprehension and storage of the memory of the abuse. Like CSA victims, intersexual children are routinely misinformed about their experiences (Kessler, 1990; David, 1994, 1995-6; Holmes, 1994, 1996; Rye, 1996; Stuart, 1996). Parents may be encouraged to keep the child's condition from him or her, with the justification that "informing the child of the condition prior to puberty has an undermining effect on its self-esteem" (Slipjer, 1992, p. 15). Parents are often misinformed themselves regarding the procedures being enacted on their children as well as the possible outcomes for their child. One medical professional (Hill, 1977) recommends "Tell parents emphatically that their child will not grow up with abnormal sexual desires, for the layman gets hermaphroditism and homosexuality hopelessly confused" (p. 813). In contrast, ISNA's statistics suggest that "a large minority of intersexuals develop into gay, lesbian, or bisexual adults or choose to change sex -- regardless of whether or not early surgical repair or reassignment was performed" (ISNA, 1995).