It is more than 30 years since the first edition of my book, Incest: Fact and Myth, was published (Nelson, 1982). Since then vast numbers of books, academic research studies, media documentaries, press articles and online materials have been produced about child sexual abuse (CSA), and its effects throughout life. What can be the justification for yet another book?

First of all, the majority have been about intervention or therapy after the event, or personal perspectives on the impact of abuse, about overcoming it or failing to do so. Fewer concentrate – as this book aims to do – on primary prevention, protection and deterrence, or can visualise a society where CSA is drastically reduced. Fewer concentrate – as this book aims to do – on campaigning for change, and on proposing models for change.

Inevitable social problem or crime?

That is not to downplay the vital need for therapy and support after child sexual abuse, which still remain far too scarce or too expensive for most survivors, and indeed this book discusses those issues at several points. But CSA is a serious crime: not some unfortunate, ever-present disease from which we can only help children and adults to recover. In other serious crimes, greatest effort goes into convicting perpetrators and reducing opportunities for further crime. We do not tackle street violence by opening head injury clinics.

CSA is also a major public health issue, with serious consequences for mental and physical health. Vital advances in public health have come through prevention (such as the provision of clean water) and through eradication of serious diseases. We did not tackle diseases of poor sanitation by building more fever hospitals. Placing the key emphasis on ‘healing’ can also lead to a comforting complacency. If children and adults can recover, perhaps CSA is not too serious? That reduces the impetus and funding for prevention and deterrence. And it clouds a harsh reality: that many courageous survivors of CSA will only ever make a partial recovery.

Much of the literature is thus heavily oriented towards a ‘convalescence’ model. This seeks effective ways of treating, counselling or healing child and adult survivors. The extent of this emphasis has been criticised by writers like Betty McLellan in her book Beyond Psych-Oppression (McLellan, 1995), and more sweepingly by the radical feminist Louise Armstrong.