Incest and Epidemiology


Unspeakable: Father-Daughter Incest in American History
By Lynn Sacco
Baltimore, MD: The Johns Hopkins University Press, 2009, 351 pp., $50.00, hardcover.

Reviewed by Mary Hamer


It’s not easy to find readers for books about incest. We’re afraid we might be contaminated, that others will think incest has been part of our lives (or, worse, that we’d like it to be). Instead of pausing to raise questions, most of us feel safer adopting a punitive stance and joining the orthodox chorus of condemnation with averted gaze.

Yet as history shows, and as Lynn Sacco’s absorbing and nuanced Unspeakable makes plain, ignorance and confusion about incest spread out to contaminate understanding in other areas. She explores the historical record to reveal how professionals in early twentieth-century America abandoned both scientific knowledge and common sense rather than register the fact that father-daughter incest was taking place right across their society.

As Sacco reminds us, it was late in the twentieth century before the work of feminists (foremost among them Judith Herman, with Father-Daughter Incest [1981]) succeeded in bringing the matter to public attention. Astonishing numbers of women came forward to identify themselves as incest survivors, yet much of the literature published in response “focused primarily on debates over psychoanalytic theories or feminist politics, not the empirical reality of incest,” writes Sacco.

Sigmund Freud set the stage for this impasse when he charged that his women patients merely desired sex with their fathers and were not reporting actual cases of abuse. That denial made it all the simpler for those bent on defending accused fathers to dismiss the newly published memories of incest as malicious or unconscious fabrications. “Without any social-scientific context in which to make sense of [the daughters’] startling claims,” says Sacco, “interest in the topic diminished as the debate reached a stalemate.”

Sacco sets out in search of materials to build that social-scientific context and to investigate the empirical reality of father-daughter incest. Drawing together evidence from disparate sources, she offers a compelling account, one that is unflinching, too, when it comes to medical detail. In choosing to approach father-daughter incest through the medium of medical history, and newspaper and law reports from the past two centuries, Sacco makes an inspired move. Stepping aside from the confusions and controversies of today, she investigates the public record to discover whether communities in the U.S. were ever aware that sex-crimes were being committed within their own borders and if so, what they did about it.

This sober investigation uncovers a curious history. “More than five hundred reports of father-daughter incest [were] published in more than nine hundred newspaper articles across the country, mostly between 1817 and 1899,” she writes. The accused fathers were often prominent, respectable white men. But there was an abrupt decline in the number of such reports after the turn of the twentieth century.

Sacco concedes that multiple factors go to account for this, from the increased control over such cases exercised by Progressive Era doctors and social workers to the closing of courtrooms to the public and the press at the request of defense lawyers. More telling, in her view, were the many threats to the stability of U.S. society, beginning in the 1890s. Labor unrest was widespread, while immigrants and newly mobile African Americans were changing familiar demographics and overwhelming the resources of cities. Against this apparent chaos was erected an idealized image of the white family, and above all of the white father and his authority, as the linchpin of modern American society.

At the turn of the twentieth century, however, advances in bacteriology and technology made a reliable diagnostic test for the discharge that denoted infection with gonorrhea vulvovaginits available for the first time. Sacco reports that doctors began to uncover what they described as an epidemic of gonorrhea vulvovaginitis in prepubertal girls. Apart from the fact that parents could and did take the diagnosis as an insult, how was the etiology of the disease to be explained? Everyone from mothers to medical professionals knew gonorrhea was transmitted sexually. And it was found not only in girls from poor families and outsider communities; “nice girls” from middle-and upperclass homes were also infected.

As Sacco explains, doctors and social workers, concerned to improve the nation’s health, could not ignore a public health problem of such dimensions. They assigned social workers and set up clinics, but they redefined venereal disease as a “family problem” imported via fathers’ use of prostitutes. At the same time, they stubbornly maintained a blind spot concerning the role of fathers in transmission within the family. Surveillance and punishment, as far as they existed, focused on the girls themselves and on their mothers. Weekly appointments were scheduled, often at distant clinics, for treatments that entailed pelvic examinations and vaginal douches. “Many girls became hysterical; sobbed and shook; tried to hide; became rigid, sweaty, and clammy; clenched their teeth; and acted as if they were being half-killed while the smear was being taken,” writes Sacco.

As far back as the seventeenth century the presence of a sexually transmitted disease in a young girl had been accepted as a sign of a previous sexual assault. In 1998 the American Academy of Pediatrics instructed physicians to assume that any gonorrhea in children had been transmitted sexually. But when American doctors in the early twentieth century were confronted with disquieting numbers of prepubertal girls who tested positive for vulvovaginitis, their ingenuity in discovering sources of infection knew no bounds. It is to these practitioners that we owe the pathologizing of the toilet seat, based on near-pornographic speculation about how contact between the girl’s body and the “infected” seat came about. (In no case, of course, was an infection ever traced to a toilet seat.) Some blamed the sharing of towels, sheets, or sponges that, they claimed, had been infected by older women, most likely by servants.

Speculation was governed by social hierarchy rather than by a framework of medical knowledge. Mothers above all attracted blame: their daughters’ illnesses were said to be caused by their poor housekeeping. Yet, as in earlier centuries, it was often a watchful mother who, suspecting her child was being abused, went to seek medical confirmation. Now she could seriously be informed that gonorrhea was a “childhood disease.” Once a rapid cure for vulvovaginitis arrived in the form of antibiotics, doctors’ anxiety around its epidemiology died away.

Moving forward from the world of Sacco’s study, can we find any greater readiness to confront the reality of incest, any greater clarity on the subject, in our own day? Remembering the outcry from disciples of the Marxist historian Herbert Aptheker when his daughter Bettina Aptheker, in her memoir, Intimate Politics (2006), revealed that he had abused her, I wonder. It can seem that the idealization of fatherhood, and the notions of the great man, the hero, the leader, survive virtually unimpaired.

At the same time, however, our understanding of what is at stake for abusive fathers has moved beyond the simply moralistic. In recent years we’ve begun to take account of the price that the fiction of masculinity exacts from men. We recognize the deformation they are asked to accept in the way of emotional restriction and in lives of daily competition. These deformations lay the ground for abusive behavior, although of course they are not a sufficient cause of it: not all men abuse. Still, writers on incest risk being accused of inappropriate sympathy for perpetrators if they pause, as I myself have done elsewhere, to ask about the man, his emotional and psychological history, and the circumstances triggering the abuse.

“We have to keep in mind that judgmental responses are of no use and are the expression of intellectual laziness,” argues a distinguished pioneer in the treatment of abusers, Estela Welldon, the author of Mother, Madonna, Whore: the Idealization and Denigration of Motherhood (1988). As a first step in dispelling confusion, Welldon emphasizes the distinction between pedophiles and perpetrators of incest. Both groups abuse children and have often had traumatic early childhoods themselves, but the resemblance ends there. Incestuous fathers shift their sexual focus from their wives to their offspring: they have often been able to form fully developed relationships with other adults and to have families. The incest may be an outcome of dysfunctional family dynamics or traumatic loss.

Pedophiles, in contrast, are intensely afraid of relating to their peer group; they connect with women only to target their underage children. They reject any notion that they are sick, insisting that sexual initiation by an adult is good for children. They resist treatment and even after treatment can remain a threat to children.

The prognosis for incestuous fathers is better: they are usually more aware of the longterm damage they are inflicting and often have some sense of remorse: on the whole, following treatment they don’t present future danger to other children.

Sacco argues that the idealization of the family blinded earlier investigators; it’s Welldon’s view that in cases of incest, it is the family and the family dynamics that are central and in need of examination. Like a perfect storm, incest has many precipitating factors. Uncovering the circumstances in which the abuse started, when it first occurred, and how, when and why disclosure took place—all these are required in order to arrive at the meaning of the act and of the relationship. Welldon points out that it’s not always appreciated how a sense of being favored or “chosen” contributes to confusion in the abused child, which will lead him or her to expect to be at the center of all confusions and ambivalences in later life.  

That’s not the end of it. The range of disorders in women and girls that are the legacies of incestuous abuse encompasses both immediate and longterm physical, psychological, and emotional problems, many of which are now being traced to changes in brain chemistry and the endocrine system brought about by trauma. As Sacco rightly notes, “The most tragic consequences of father-daughter incest are neither ideological challenges nor gonorrhea infection, however widespread.” Far from transient in its effects, as some might like to imagine, incestuous abuse poisons young lives at the root, throwing a lasting blight over their future.


Mary Hamer is an independent scholar who taught at Cambridge before becoming a fellow at the Bunting Institute (now the Radcliffe Institute). She is an associate of the DuBois Institute at Harvard University and a member of the Clink Street Writing Group. Her books include Incest: a New Perspective (2002).  


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