Between Denial and Distortion

Psychoanalysis and Child Sexual Abuse — Part II: "Constructions Make Reality"

Thursday July 9, 2026

Freud was a genius at making constructions and it may not be too farfetched to attribute to him the motto "Constructions Make Reality." In this respect he shows an affinity with two sources with which he was not actually familiar: the Talmud and Hegel's philosophy.

— Erich Fromm, Greatness and Limitations of Freud's Thought, p. 138–9.

Context

If Freud never denied the reality of childhood sexual abuse, where did the belief that he did originate?

When I first began revisiting Masson's "The Assault on Truth" in preparation for this article, I was struck by the exegetical nature of his writing. I mean by this that Masson, piecing together citations, takes great pains to infer from these citations what he believes Freud must have done when confronted by patient reports of childhood sexual abuse. He does not cite actual accounts of what Freud did, either from Freud's own case notes or from third-party accounts. This is all the more striking given that Masson had full access to the Freud Archives, suggesting, perhaps, that such materials are unlikely to exist.

When this realization dawned on me, I began to wonder why Masson did not search for lower hanging fruit. Surely if Freud had dismissed reports of childhood sexual abuse as fantasy, other analysts past and present would have as well? If Masson was concerned about patient abuse by psychoanalysts, where were the reports from his own era? Had anyone actually documented a systematic issue with the way psychoanalysts and psychoanalytically informed therapists approached reports of childhood sexual assault?

In order to answer these questions, this essay works backwards from a largely overlooked author, Florence Rush, in order to trace one possible path backwards through the history of psychoanalysis: from Peters in 1976, through Katan and Greenacre at mid-century, to Abraham in 1907, and finally to Freud himself. The consideration of other authors such as Bender and Blau, and of dissenting viewpoints such as those of Ferenczi and Fairbairn, would be important for a comprehensive treatment of the subject, but is outside the necessarily limited scope of this essay.

Florence Rush: An Infamous Tradition (1980)

Rush first presented her thesis publicly in 1971 at the New York Radical Feminists Rape Conference. She published it in 1977 as "The Freudian Cover-Up" in the feminist journal Chrysalis, and in expanded form in 1980 as Chapter 7 of The Best Kept Secret: Sexual Abuse of Children. Her thesis anticipates Masson's in its essentials — in print by seven years, in public by thirteen.

In the original text of The Assault on Truth, Masson mentions Rush only once, in passing, in a list of authors. It is only in the prefaces and afterwords to later editions that he acknowledges her book and describes himself as standing alongside her and other feminist writers.

Rush was a social worker who had spent years working with children who had been sexually abused and then failed by the institutions that were supposed to help them. Unlike Masson, text interpretation is not her primary source of information, but rather real factual reports of clinical interventions. The following are drawn from Rush's professional case files and from testimonies of women who later approached her:

• Annie (age 12): Two years of incest with father (father imprisoned for robbery, not incest). Rush told Annie that she knew about the abuse and offered to let her talk about the experience or not, as she wished; her intention was to help Annie understand that her father, not Annie, was the guilty one, and he the one who should be ashamed. Rush's supervisor (a psychiatrist) was appalled; he insisted the actual event didn't shame her, rather "her deep, unconscious, incestuous wish for her father" caused the guilt. Instructed Rush never to address the abuse directly but to help Annie understand her shame came from "her own deep sexual desires."
• Unnamed 1 (age 15): Groped weekly by her orthodontist from age 9 to 14. Told her mother after the final visit. Mother sent her to a therapist rather than confronting the orthodontist. Therapist "hardly talked about it" and concluded she was "disturbed because deep down I really enjoyed it." She stopped talking about it.
• Unnamed 2 (age 10–13): Father began with hugs and kisses, escalated to genital fondling over three years. At 13, told her mother. Mother's response: "Don't tell your grandmother." Sent to Navy psychiatrist who put his hand on her leg and told her "all little girls attempt to seduce their daddies." Sent to live with grandmother the next morning.

None of the clinicians in Rush's case material are identified as psychoanalysts; they are psychiatrists, supervisors, and therapists who may or may not have had psychoanalytic training in some form, or who may have absorbed Freudian language from the broader psychiatric culture without any direct connection to psychoanalytic training or practice.

Rush, however, traced the problem directly to Freud, arguing that his abandonment of the seduction theory and, according to Rush, Freud's denial of the reality of childhood sexual abuse, had created a professional culture in which the dismissal of children's reports of sexual abuse was not merely permitted but theoretically mandated.

Rush's conclusion — that Freud himself had denied the reality of abuse and that the psychoanalytic establishment had followed his lead — was wrong on the facts, as Part I of this essay shows. This is, however, a secondary issue when compared with her actual observations: that the psychoanalytic theoretical framework was being used as a pretext for dismissing patient reports of childhood sexual abuse.

Joseph J. Peters: A Prolonged Oedipal Wild Goose Chase (1976)

In 1976, Joseph J. Peters, a psychiatrist and director of the Philadelphia Sex Offender and Rape Victim Center, published "Children Who Are Victims of Sexual Assault" in the American Journal of Psychotherapy. Peters was both a psychoanalytically trained clinician in private practice and the director of a clinic that saw hundreds of child victims brought in by third parties and confirmed by medical examination. Rush quotes Peters approvingly at several points in her book and uses a quote from this paper as the epigraph for her Chapter 7, "A Freudian Cover-Up." The passage, quoted here as Peters wrote it (Rush's epigraph silently alters the wording) runs:

It is my thesis […] that both cultural and personal factors combined to cause everyone, including Freud himself at times, to welcome the idea that reports of childhood sexual victimization could be regarded as fantasies. This position relieved the guilt of adults. In my opinion, both Freud and his followers oversubscribed to the theory of childhood fantasy and overlooked incidents of the actual sexual victimization in childhood.

[…] reports of sexual assaults upon children are ignored or discounted at the expense of the psychologic well-being of the child victim.

Peters is emphatic in repeatedly stating that

In their aversion to what are often repulsive details, psychotherapists allowed and continue to allow their patients to repress emotionally significant, pathogenic facts. They ascribe to childhood fantasy, which is a common developmental process, actual childhood assaults.

Evidence for this practice is, however, not drawn from third-party reports, but from one of Peters' actual therapeutic failures. In "Case 2," Peters recounts his treatment of a thirty-three year old woman whose anorexia nervosa Peters was attempting to treat with hypnosis. During the first session, the client began crying and called out, "Daddy, don't leave me. I wish mother were dead." After the session, the client alluded to a significant event that happened when she was four years of age. Peters concluded that "unresolved oedipal fantasies were the primary problem" and abandoned hypnosis. There followed years of weekly sessions exploring oedipal material before dream analysis finally revealed an actual childhood rape at the age of four and a half, committed by a babysitter while the mother covered up the incident. In all, it took eighteen years of weekly sessions before the patient reached a complete remission of symptoms. His own reflection: "Would not an earlier recognition of the actual childhood rape have saved us many hours of analysis? […] Was this not a prolonged oedipal wild goose chase?"

Peters notes that, with one exception, all of the sexual assaults in his private practice cases were independently corroborated by a third party. The rape was real; it was Peters' failure to find it that lasted eighteen years. He notes laconically, "Ascribing these events to psychologic fantasy may be easier and more interesting for the therapist, but it may also be counterproductive for the most efficient resolution of symptoms."

Anny Katan: Perhaps Not Their Fathers (1973)

Peters cites a paper by Anny Katan, "Children Who Were Raped" (1973), in support of his claim that analysts too readily dismissed reports of abuse.

Katan reports on six women she had analyzed, all of whom had been raped in early childhood. Her two fully documented cases present strikingly different evidentiary pictures. Mrs. A's father was genuinely and severely abusive: he placed her on his lap with her genitals touching his, grew sexually excited, and bit her hard enough to break the skin. At the age of five, she was also orally raped by a stranger in her school basement. Mrs. A's memory of the stranger's assault was, in Katan's words, "never fully forgotten," though further details emerged and were remembered as the analysis progressed; her memories of the father's abuse likewise surfaced over the course of the analysis rather than being completely remembered from the beginning.

Mrs. B's case is different: at age three, she was raped by the boyfriend of a nursemaid. Katan states that this incident was "repressed, completely unconscious," and emerged only in the course of the analysis, after an episode of "acting out."

In her discussion, Katan offers a striking hypothesis:

I have often wondered whether these patients of Freud's had not been right about one thing. The sexual seduction or rape that victimized them in early childhood may well have been a reality but was attributed by them to the wrong person, to their fathers. Not only Mrs. A., whose father behaved so incestuously and abnormally, but five of my six patients attributed in their fantasies the sexual deeds to their fathers.

This hypothesis — that Freud's patients may have been reporting real abuse attributed to the wrong person — is intriguing, but it is not clearly supported by Katan's own case material. Mrs. A's father was genuinely abusive, so her "confusion" of father and stranger is a merging of two real abusers, not an attribution of a stranger's assault to an innocent father. In Mrs. B's case, the "merging" of the father with the nursemaid's boyfriend is Katan's interpretive conclusion about the child's internal world, not something Mrs. B appears to have reported as a belief or a memory. What "attributed in their fantasies the sexual deeds to their fathers" actually means, whether these patients consciously accused their fathers or whether Katan is describing oedipal fantasy material she observed in the analysis, is left unclear.

To her credit, Katan clearly recognizes and takes seriously the reality of childhood sexual abuse. More broadly, however, her case reports show signs of a theoretical framework being superimposed on material that does not clearly support it. She infers the specific nature of Mrs. A's abuse ("seduced by a man who approached her from the rear") from symptoms, before hearing the patient's history. Mrs. B's assault is entirely recovered in analysis, not independently corroborated. Although Katan clearly sees and acknowledges the abuse, her reading of its psychic consequences is shaped by a drive-theoretical apparatus (drive fusion, phallic fixation, libidinal development) whose fit to the reported material is asserted rather than demonstrated.

Phyllis Greenacre: Blaming the Victims (1949, 1950)

Where Katan took her patients' reports of abuse seriously, the work of Phyllis Greenacre, a prominent analyst at Cornell, presents a more troubling picture.

In her 1949 paper "A Contribution to the Study of Screen Memories," Greenacre describes a patient who, at the age of six, "suffered a severe sexual trauma in seeing some man exposed and masturbating." Greenacre is unable to identify the perpetrator: "From the analytic material it seemed probable that this was the schizophrenic cousin who had the same name as her father, or a foreign handy man who worked around her father's place of business." She adds that "both figures appeared frequently fused with that of the father, and it seemed clear that she projected on to her father her reaction to this experience and to an even more severe sexual trauma of attempted rape, to which she was seduced by being given money."

Greenacre's evidence for the rape consists of the following: a ruptured hymen, first discovered in the patient's early twenties, "which she unconsciously understood in attributing it to having ridden horseback too vigorously." The patient had no conscious memory of a rape. At the beginning of the analysis, "this rape experience appeared only projected as a memory that her mother had had a severe operation for gall stones and hysterectomy when the patient was 6." The mother did have such an operation, but when the patient was 10, not 6; Greenacre infers that the memory was "projected backward."

From this material, Greenacre concludes: "The traumatic experiences were unusually severe, the sight of the man masturbating and the experience of rape, both occurring with men who were associated to an unusual degree with her father. It is probable that this patient was really a very seductive little girl, who was predisposed by long exposure to sexual scenes and that she cooperated in the instigation of these experiences."

It is worth pausing to consider what the clinical material actually supports. The patient does not report a rape. The identity of the alleged rapist is uncertain. The patient has no conscious memory of the event. The ruptured hymen, the sole piece of physical evidence, was discovered decades later and attributed by the patient to horseback riding, an explanation that is at least as plausible as Greenacre's, since a ruptured hymen is not reliable evidence of sexual intercourse. The "fusion" of the perpetrators with the father is Greenacre's reading of the analytic material, not the patient's report. In short, the rape appears to be a theoretical construction, assembled from screen memories and analytic inference through the drive-theoretical framework. And from this construction, Greenacre concludes that the child was "seductive" and "cooperated" in her own assault.

Greenacre's 1950 paper, "The Prepuberty Trauma in Girls," extends this pattern. She consistently describes children as having "precipitated," "provoked," or "induced" their own assaults. Her summary states: "These traumata were provoked by the victims." One of the cases involves a ten-year-old girl roller-skating in her own basement when a man entered and sexually assaulted her. Greenacre's framework leads her to describe this as an event the child "precipitated."

It is important to emphasize that, like Katan, Greenacre is not denying the existence of childhood sexual abuse. Greenacre is fully engaged with the material, clinically competent, and looking at the evidence. What is unsettling, however, is the degree to which the childhood sexual abuse appears to be inferred or constructed from Greenacre's theoretical framework. In addition, Greenacre's theoretical convictions skew her viewpoint towards seeing traumatic events, at least in part, as driven by the child's wishes and internal dynamics. This is reflected in language she uses to describe the patients' conduct: a six-year-old becomes "seductive," a ten-year-old "precipitates" her own assault. The theory produces this reading without Greenacre recognizing it as distortion.

Karl Abraham: Rape as Infantile Sexuality (1907)

In 1907, Karl Abraham, one of Freud's closest associates and eventually the founder of the Berlin Psychoanalytic Society, published "Das Erleiden sexueller Traumen als Form infantiler Sexualbetätigung" ("The Suffering of Sexual Traumas as a Form of Infantile Sexual Activity"). Among other issues, the paper attempts to explain, first, why some children actively resist sexual assaults while others do not, and second, why some sexually assaulted children immediately tell their parents about the assault, while others do not.

With respect to the first question, following a discussion of historical and literary sources including Mosaic law (Deut. 22: 22–27), Abraham concludes that in cases where there is an opportunity for the child to resist the sexual assault but the child does not cry for help, flee, or resist, there must be an "accommodation" (Entgegenkommen, literally "coming towards") on the part of the child. In other words, the child must have wanted the sexual assault to happen.

With respect to the second question, Abraham compares a child that does not tell its parents about a sexual assault to "a child that has injured itself in the course of a forbidden game" and concludes: "the child has succumbed to the allure of the forbidden and has the feeling that it is responsible for its accident."

What is striking about Abraham's clinical formulations is their tunnel vision: Abraham does not consider the role that fear might play in the sexual assault, or the child's prior experience of whether it will be believed by its caretakers. This is an artifact of Abraham's strict adherence to the explanatory framework of the drive-defence theory, according to which all mental pathology is caused by the repression of sexual drives, which is to say: the only conceivable source of pathology is the repression of a forbidden sexual wish. What this boils down to is that the only tool to explain the damaging effects of sexual assault in the drive-defence theory's interpretative instrumentarium is: "You secretly enjoyed it and wanted it to happen."

It is worth noting that Freud himself was highly critical of Abraham's thesis in private, telling Abraham that "the dividing line between consciousness and unconsciousness has not yet been established in early childhood," meaning that unconscious sexual purpose cannot be attributed to a small child.

Freud continued, for reasons of his own, to support Abraham in public. Abraham all but fell silent on the subject, returning to it only in passing in a 1913 paper on neurotic exogamy, until, thirteen years after Freud's critique, he added a terse postscript in 1920 acknowledging "certain errors in its rendering of Freud's views." He never again treated the subject at length in print (Good, 1995).

Sigmund Freud: Disgust Is Desire (1905)

The documentary evidence that Freud never denied childhood sexual abuse is overwhelming. But the record is not without complication. Although it does not directly involve denial of the facts, in the Dora case (Bruchstück einer Hysterie-Analyse, published 1905 but written 1901), one of Freud's greatest therapeutic failures, the facts are acknowledged while simultaneously being retrofitted into Freud's theoretical constructions.

The case in question is that of Dora. Dora's father, whose real name was Philipp Bauer, was an ex-patient of Freud who had previously consulted him for syphilis-related symptoms. The situation at the time he asked Freud to treat Dora was approximately the following: he had infected his wife with venereal disease; possibly transmitted congenital syphilis to his children; maintained a barely-concealed affair with Frau K. while presumably exposing her to the same risk; and for all intents and purposes offered his adolescent daughter to Herr K. in exchange for continued access to Frau K. He also told Freud his daughter was lying about Herr K.'s advances towards her.

Freud saw most of this clearly including Bauer's self-serving dishonesty, the affair, and the syphilitic infection. But none of this could be captured in the theoretical framework that he was using, the drive-defence theory. Working backwards from theory to fact, Freud systematically eliminated everything from the situation as a possible cause or contributing factor to Dora's complaints except for Dora's supposedly repressed sexual desire for Herr K.

Consider the following episode. At one point in her analysis with Freud, Dora described how, at fourteen years of age, Herr K. took her by surprise, embracing and kissing her. She felt intense disgust and fled the scene. Freud's analysis of the episode:

In dieser, der Reihe nach zweiten, der Zeit nach früheren Szene ist das Benehmen des 14jährigen Kindes bereits ganz und voll hysterisch. Jede Person, bei welcher ein Anlaß zur sexuellen Erregung überwiegend oder ausschließlich Unlustgefühle hervorruft, würde ich unbedenklich für eine Hysterika halten [...] Anstatt der Genitalsensation, die bei einem gesunden Mädchen unter solchen Umständen gewiß nicht gefehlt hätte, stellt sich bei ihr die Unlustempfindung ein, welche dem Schleimhauttrakt des Einganges in den Verdauungskanal zugehört, der Ekel.

In this scene, second in sequence, earlier in time, the behaviour of the fourteen-year-old child is already entirely and fully hysterical. Any person in whom an occasion for sexual arousal predominantly or exclusively provokes feelings of displeasure I would without hesitation consider a hysteric [...] Instead of the genital sensation, which in a healthy girl under such circumstances would certainly not have been absent, the feeling of displeasure belonging to the mucous membrane tract of the entrance to the digestive canal presents itself, namely disgust.

Freud's analysis requires little in the way of critical commentary except perhaps to point out what happens when the primary allegiance of the therapist is to theory rather than to the patient.

The Real Picture

What, then, are we to make of all this?

Part I of this essay showed that Freud never denied the reality of childhood sexual abuse. Part II has tried to show that the picture is considerably more complicated than the popular narrative suggests.

Rush documented real therapeutic failures including children whose reports of abuse were dismissed, reframed as fantasy, or used against them. In attempting to trace the problem to Freud's personal denial of abuse, Rush was, however, factually incorrect, and it is unclear whether the clinicians in Rush's case material were psychoanalysts, although they appear to have made use of parts of psychoanalytic theory.

Peters, a psychoanalytically trained clinician, admitted to an eighteen-year treatment in which a focus on oedipal fantasy prevented recognition and acknowledgement of a real childhood rape. His case is the only published first-person account of this kind that I have been able to find, and its rarity is itself significant: the conditions under which an analyst's clinical failures become visible are extremely narrow. Clinical confidentiality ensures that what happens in the consulting room stays there. For every Peters who publishes his failure, there are presumably many who do not. The scope of the problem is structurally unknowable.

Katan took childhood sexual abuse seriously while superimposing a theoretical framework whose fit to the reported material was asserted rather than demonstrated. Greenacre, working within the same tradition, went further: the imposition of the theoretical structure is more incisive than it is in Katan, leading her to conclude that children were "seductive" and had "cooperated" in their own assaults. And Abraham, writing in 1907, had articulated the same logic four decades before Greenacre, a logic whose application to small children Freud himself privately rejected.

The drive-defence framework did not compel any of these outcomes. It is a lens that bends perception in a specific direction: toward the child's desire and away from the adult's aggression. How far it bends depends on what the analyst brings to it.

Nor is this an artifact of early doctrine alone. Whatever the theory formally admitted after 1920 (aggression as an independent drive, the elaborations of ego psychology), in clinical application pathology continued to be routed through repressed libidinal conflict. Greenacre had access to this vocabulary in principle; her clinical readings make no use of it.

It would be wrong, however, to conclude that the problem is simply one of individual analysts. The theoretical vocabulary of the drive-defence model ("oedipal fantasy," "seduction wish," "traumatophilia") provides a respectable language for relocating agency from the adult perpetrator to the child victim. An analyst who lacks the clinical resources or the personal courage to sit with the horror of what a child has endured can reach for this vocabulary and produce a reading that provides the analyst with comfort at the patient's expense.

It bears noting that authorities disbelieved children long before Freud and will continue to do so long after Freud. No one needs a psychoanalytic theoretical framework to dismiss a child's report of sexual abuse. What the framework provided was a vocabulary that made the dismissal look rational and masked that it was in fact an expression of the therapist's own madness.

Fromm's observation that Freud's motto might as well have been "Constructions Make Reality" applies not only to Freud but to one clear strand in the tradition that followed him, and nowhere more consequentially than in its treatment of sexually abused children. What we see in this developmental line, consistently, is theoretical commitments being imposed on clinical material in violation of the basic principles of common sense, distorting the clinical picture and potentially causing serious harm to the very patients the theory was supposed to help.

This is, in the end, a story about what happens when a theoretical lens shapes perception in ways that the people looking through it do not wish to see.

Bibliography

Passages Cited