'You're a paedophile!" said a female patient in a low security rehabilitation unit to one of us. This young woman claimed to have been repeatedly sexually abused as a child. She now had a diagnosis of paranoid schizophrenia. When she was asked for evidence of her assertion, she replied: "All men are paedophiles."
The extent of this young woman's delusional thinking became even more obvious and bizarre when she said that male nurses were trying to rape her at night.
A prisoner, currently serving a life sentence for murder, alleged that he kept seeing the face of an uncle when his crime was committed. This uncle had repeatedly sexually abused him as a child. The victim was a homosexual man who had made unwanted sexual overtures. Studies show that the numbers of men on death row in the United States who claim to have been sexually abused as children is exceedingly high - over 50 per cent in some cases.
Can child abuse wreak such havoc in people's lives? Would our prisons and mental hospitals be less full if we provided better protection for our children? Should education on child protection matters have a higher priority in the school curriculum? Should it be on the curriculum at all?
There are those who argue: a) that school-based abuse prevention programmes improve children's knowledge and skills with respect to helping them avoid becoming victims of sexual abuse; b) that the knowledge and skills gained in the school setting do actually transfer to real life abusive situations; and c) that preventative education carried out in schools does increase the likelihood of pupils disclosing sexual abuse which occurred in the past or which may still be going on.
But do preventative programmes carried out by teachers or educational psychologists brought in for this specific purpose work? The evidence is mixed.
Child sexual abuse is not a diagnosis or a disorder. It is a complex life experience for many. Some are dreadfully affected by it, while some are not so damaged.
School-based prevention programmes proliferate, particularly in the US.
They vary considerably in relation to the length of time they last, the actual material used, the presentation medium (for example, puppets, role play, cartoons, video, songs or stories), who delivers the programmes, and whether or not celebrities are involved.
However, the programmes also have much in common. Firstly, they all try to get across to children what sexual abuse is and what it is not. This includes the idea of body ownership (your body is your own), acceptableunacceptable touching, and goodbad secrets.
Secondly, they all attempt to translate knowledge into skills such as the ability to say no and to go and tell someone you trust - the "no, go, tell"
strategy, as it is sometimes called. To be any good the skills learned must be transferable into real-life, potentially abusive situations.
And thirdly, the programmes aim to try to make it easier for the children to disclose on-going or past abuse, or indeed any suspicious overtures made by adults.
Do the sexual abuse programmes succeed in their basic aims? With respect to them imparting knowledge that they were trying to convey, results are generally positive. In a meta-analysis carried out in 2000 of 27 studies (by Davis and Gidycz), the concept knowledge of children was increased.
The attribution of blame to the adult perpetrators (as opposed to children blaming themselves), perpetrators being more likely to be family members than strangers, the fact that both boys and girls can be targets of abuse, and that disclosing abuse to trusted adults is of the utmost importance, were all known about in more detail by children in the programmes compared to those who had not been in them.
As one might have expected, it turned out to be far more difficult to find evidence that the knowledge these children had acquired could be translated into the skills needed in real abusive situations. Only a few studies have been undertaken which have tried to assess the effectiveness of this new knowledge in practice.
One such study interviewed several thousand children, two-thirds of whom had participated in child abuse prevention programmes and one-third had not.
Of those who had, more of them were less likely to blame themselves as opposed to the adult perpetrators. They were significantly more likely to use protection strategies such as assertiveness and non-compliance. And they were more likely to feel that they had been successful in protecting themselves.
Another study (Gibson et al, 2000) investigated whether children who had completed a prevention programme were less likely to be approached by a potential perpetrator in the first place. Results showed that children who could not remember ever having taken part in a child sexual abuse prevention programme were almost twice as likely to have been abused subsequently than those who could remember having been involved in such a programme.
These findings might lead one to conclude that the prevalence of sexual abuse must be falling in parts of the world like North America where 85 per cent of school districts actually provide these school-based sexual abuse programmes. Sadly, a meta-analysis of numerous research studies (Bolen Scannapieco, 1999) has shown that, not only have prevalence rates not reduced, they have in fact increased substantially over the previous 15 years.
Is the picture any better when we look at the possibility of school-based prevention programmes promoting disclosure of abuse? Thankfully it is better. While there is some contradictory evidence, on the whole most studies (for example, Finkelhor, 1995) report a significantly greater number of disclosures among children who recall having participated in a prevention programme.
Many victims in real-life situations could remember some aspect of the prevention programme and, though what they remembered did not save them from the abuse itself, it did prompt them to disclose the abuse and thus put an end to it.
"All men are paedophiles," said the young schizophrenic woman in the mental hospital.
Of course they are not. However, it would appear that many are - given the opportunity. A huge number of children suffer sexual abuse that can have a devastating impact on later life. If we can do anything to reduce the chances of any child being abused, we should. And the resources should be made available now.
Judith Jamieson is a psychology support assistant at Daldorck residential school for autistic children in Catrine, Ayrshire. John Jamieson is a former principal educational psychologist