PSYCHOLOGICAL ABUSE & NEGLECT IN PAKISTAN: INTERPRETIVE PHENOMENOLOGICAL ANALYSIS IN ADOLESCENTS

In recent years Pakistan amassed several reported cases related to child abuse and neglect. Abuse and Neglect are universal phenomena its roots are lying in historical perceptions where children were considered an object of mistreatment for customs and considered possessions by caregivers and other stakeholders. Abuse and neglect against adolescents exist in every culture and its forms are shaping and emerging based on the practices and systems of the culture. The purpose of the current study was to explore the form of abuse & neglect existing in culture among adolescents. To examine the forms of abuse and neglect that exists in Pakistani culture and to summate the experiences of the adolescent’s Interpretive phenomenological analysis was used to interpret and conceptualize themes. This study explored adolescents experiencing sexual abuse: sexual exploitation, blackmailing, Incest perpetrators, and physical abuse: Harsh discipline practices, dominance & control, and harmful traditional practices prevailing in Pakistani culture. Further to address the issue it is a spirited requisite to improve the management of the abused and neglected victims and a dire need to prevent long-term mental health consequences along with addressing to strengthen positive parenting practices, referral systems, and child protection policies in Pakistan.


INTRODUCTION
Childhood experiences leave a long-lasting impact on children's and adolescents' mental health and emotional development (Xiang et al., 2020). Abuse and Neglect are the major factors that can impact a child's life in all domains, physical, psychological-emotional, and social. Adverse childhood experiences can leave scars on a child's soul permanently (Dahake, 2018). The child takes dynamism from their parents and caregivers however literature revealed that parents play a vital role in neglecting a child and adolescents probably unintentionally (Tarantola, 2018). Abuse and neglect occur to adolescents under the age of 18 specifically sexual abuse occurs within the age range of 2-17 years (Gewirtz-Meydan & Finkelhor, 2020). Nearly adolescents from the age of 17 years suffer from physical violence and psychological abuse by their parents and caretakers (Mažeikaitė &, Kėvalas, 2019). Globally every third of women and 13th man reported experiencing sexual abuse in childhood (Gonzalez, 2021). The literature revealed that child abuse includes physical, and emotional sexual violence, and negligence. Despite these forms of abuse, there are other ill-treatments including exploitations and commercial violence which cause threats and harm to a child's dignity, survival, and development (Khandagale & Chaven, 2019).
Early years of child development are essential for the positive growth of adolescents but exposure to any form of abuse puts adolescents' healthy mental development, identity formation, and socialization at threat and the long run leads to psychiatric disorders (Penner et al., 2019). The age of adolescents is related to foremost life challenges like peer pressure, career challenges, pubertal issues, and academic goals. This life phase demands more guidance and support from parents (Vazquez-Ortiz et al., 2020) especially to develop positive relationships (Okunlola et al., 2020). Stakeholders are the caretakers and parents who are responsible to protect adolescents from any harm and danger (Gonzale et al., 2021). Unfavorably family and known masses are responsible to victimize adolescents for abuse and neglect that led to adverse impacts on adolescents' health, education, and behavioral aspects. (Mathews et al., 2020). Adolescent age is at a higher risk of abuse and neglect particularly experience more abuse than other age phases. Abused adolescents also experience related other types of abuse (Baeg et al., 2020). In adolescents, it carries long-term mental health consequences as well as an interruption in early brain development (Almuneef, 2021). Studies found that abuse and neglect, loneliness, and mental health problems are positively associated (Bosoglu Emre, 2019). Also direct them to avoidance, negative emotions, and emotional suppression (Gruhn & Compas, 2020). As if adolescents are at risk of greater mental health, and behavioral and physical problems (Lippard & Nemeroff., 2020). In the long run, they could be involved in risky behaviors, smoking, addiction, high-risk sexual behaviors, mental health problems depression, anxiety, alcohol, and substance use (Kisely et al., 2018).
According to the Pakistani context, the Sahil organization indicated that every day eight children become a victim of sexual abuse. More than 1000 cases of sodomy and sexual assault against girls and boys show that most perpetrators are in close relations (Sahil's Cruel Numbers 2020). On the other hand, physical abuse in schools is more than 80% in one city, and sexual abuse is also common (Mehnaz, 2018). Although there are policies to protect children and adolescents from all forms of abuse and neglect according to the United Nations Convention on the Rights of the Children (UNCRC, 2011) children have the right to survive, health, and protection from violence and exploitation. (Van der Put et al., 2018). Regrettably, its immediate implementation is challenging and cases are left unaddressed without the provision of justice or delayed.
Culturally from the Pakistani perspective, it is stigmatizing to speak about sexual abuse. The Incident of Zainab convinced the community to raise voices against child sexual abuse. The family of Zainab breaks the silence against rituals and social barriers for justice. Their initiative brought the community to acknowledge the issue of child sexual abuse to protect children and adolescents at psychological, legal (justice), and management level (The Guardian, 2020).
There is a calamitous need for dependable material that could provide profound knowledge about abuse and neglect existing in our culture. In the local context how adolescents' perspectives on the ways of abuse and neglect are different or similar. What is the level of cultural understanding about the burning issue its demands to address the problem and how to reduce its causes and impact? There are several studies conducted to address abuse and neglect. The uniqueness of the study is to understand the perception of adolescents about abuse and neglect through interpretive phenomenological analysis to conceptualize the experiences of abuse and neglect.

Study Design
The study aimed to explore the perspectives of adolescents about abuse and neglect. For this purpose, interpretative phenomenological analysis was used. The interpretative phenomenological analysis is a qualitative research method to explore the details that how participants make sense and meaning to their personal and social world (Smith & Osborn, 2007). Therefore this method was chosen to explore the lived experiences of the adolescents, particularly the ways adolescents perceive abuse and neglect prevailing in cultural contexts the data were rich that could be gathered through qualitative research.
The sampling method of the study was convenient sampling. Convenient sampling was chosen to approach adolescents conveniently (Bornstein et al., 2017). As the participants were taken from areas of the mainstream Government schools based on the availability of data collection. For the process of the study, a semi-structured interview was used to collect data as the semi-structured interview is a useful interview technique for mounting interview questions (Doyle, 2020) in processing interviews also helpful for the participants to go into depth to talk freely about the issue Psychological Abuse & Neglect in Pakistan they considered valued. As the study aimed to explore the abuse and neglect in our culture adolescents are experiencing that demands in-depth interviews and cautious interpretation of their perspectives therefore the interpretive phenomenological analysis was used to analyze the data. Participants There were eight adolescents 'four girls and four boys ages 12-16 participated in the study. Participants were randomly selected from the mainstream Government Schools with similar socioeconomic backgrounds from urban and rural areas. Orphans and separated families' adolescents were excluded.  (N=8) The study included eight adolescent boys and girls aged range 12-16 years, grades 6 th -10 th . Constructing the Interview Guide. To investigate the problem researcher's required to develop the interview guide along with developing the relevant probes for the interview. The purpose of the interview guide was to enable the interview procedure. Interview questions were based on the empirical literature and the interview guide was prepared to avoid the inconvenience of imposing questions in a harmful way. In the interview, the guide was validated by the two experts in the area of the study. Their suggestions were incorporated into the final guide. Pilot Study. Piloting of the study before initiating the study carried out nearly four participants from different schools were taken to interview to ensure the participant's understanding and clarity of the interview questions. The aim was to examine the sensitivity, suitability, and clarity of the interview questions. The editions, feedback, and suggestions were incorporated, few words were modified to get access to relevant rich data.

Data Collection
For the procedure of the data collection schools head were informed. The school authority further connected with the teachers to access the participants based on the required demographics for the study. The aim, procedure, and method of the interview were explained. The interview place was in the school building where the participants were conformable and felt the freedom to express their experiences. Informed consent was taken from the participants before the interview and was informed about note taking of the researcher. All information was written properly. Every participant on average took 45-60 minutes. All personal information is kept confidential to maintain participant dignity and for ethical liability. Participants were offered counseling services in the end.

Ethical Consideration
The research was approved by the institutional review board. To conduct the study the school heads' permission was taken before the interviews. Proper ethics were explained to participants consent was taken from school authorities. Participants' consent was also taken as a priority, ensuring the confidentiality of the personal information and records. Right to withdraw was explained that they can avail that opportunity at any level of the procedure. The interview was conducted on school premises where the participant was comfortable and parted.

Data Analysis
Previous knowledge and study on the subject ought to be sufficient for the researcher to ensure the credibility of the results (Creswell & Miller, 2000). The researcher's concern was to identify the perception of the adolescents of the forms of abuse and neglect existing in our culture. What and how are adolescents experiencing abuse? How do key stakeholders humiliate adolescents? How do boys and girls gender wise experiencing abuse and neglect in different ways?
To get deeper details and to get a healthier understanding of the experiences of the participants. Data was carefully interpreted by applying an idiographic approach and an inductive approach (Rehman, 2020). Data were interpreted according to the IPA (Smith & Osborn, 2008). In the first phase IPA by the procedure facilitate the researcher to understand and familiarize the wording of the participants then deeply into the context, insight acquaintance, and deeper understanding of the participant's internal frame of reference. The researcher sees the world through the eyes of the participant to get into his/her perspectives along with giving meaning to the experiences of the participants.
In the second phase taking initial notes, interpretation was required from original data to give meaning to the participant's experiences. In the third phase, initial notes were altered into psychological terms and then converted into emergent themes. During the fourth phase, emergent themes proceeded by clustering themes that are alike and put under on superordinate theme. Eventually, as a result of the process, the superordinate themes were generated with sub-themes.
Final phase superordinate themes and subthemes were reflecting the original verbatim of the participant's then the connection between emergent themes was properly examined to ensure that nothing was misinterpreted and included without the context of the participant's experience. The same for all participants were participants were evenly notified of the connection between the perceptions, verbatim, and experiences of the participants.

RESULTS
The section will present the superordinate and sub-themes from the analysis based on in-depth descriptions of their perspectives. Table 2 will display the superordinate and subthemes.

Sexual Abuse
Sexual abuse is unwanted sexual activity when the perpetrator is forcing, threatening, and taking advantage of the victim who is unable to give consent (Frentzen et al., 2022). Globally estimated by the World Health Organization (WHO, 2021) that every fifth of girls suffered sexual abuse at the age of 0-17 years. In Pakistan, Sahil (Cruel Numbers, 2021) estimates that nearly 8 are the victim of sexual abuse every day. Sexual abuse emerged as one of the main themes conceptualized. Participant's revealed sexual abuse linked to emotional threats, petrifying to hide secret touch, being beaten by the perpetrator, inappropriate touch, touching secret parts of the body, and sexual exploitation. Adolescents described how perpetrators use different means to exploit them. Emerging subthemes are Exploitation, Blackmailing, and Incest perpetrators. Exploitation. Exploitation is one of the themes defined as an act of acting someone unfairly for their benefit or work. Participants described exploitation in various ways such as sexual and emotional as participants verbatim revealed "She has been beaten by the perpetrator he exploited her and threatened not to tell anyone". As perpetrators exploit sexual and emotional threats to gain their benefit as the participant described that "Perpetrator threatened her not to disclose sexual activity otherwise she will be blamed by society for wrongdoings, unfortunately, fear of stigmatization and labializing terrorized adolescents and they keep quiet and feel as if that was their fault. Blackmailing. blackmailing is universal in all cultures it is demanding ransom or benefits from another benefit a return for not revealing damaging or compromising information about them. The perpetrator blackmails the victims not to disclose their personal information about sexual assault to save their position in society. The result of blackmailing is that the adolescent takes all responsibility as if it is all his/her mistake. Such as it is described by the participant "as that perpetrator inappropriately touched and used her secret body parts but on the resistance, he beats and emotionally blackmailed not to disclose and resist" Further participant described that she feels "on disclosure she will commit suicide". Suicidal thoughts as a consequence of sexual abuse were described by participants. Subsequently revealed by the participant that the "Perpetrator hit and

Psychological Abuse & Neglect in Pakistan
terrorized her that do not tell anyone about sexual assault otherwise he will exploit her again". Perpetrator target adolescents who easily become terrorized. There are no friendly spaces and supportive environments where adolescents can raise their voices and report against perpetrators. Incest Perpetrator. The Majority of perpetrators are incest common (Sahil's Cruel Numbers, 2020) states highest sexual abuse occurred by own close relations. Participants revealed that "immediate family member inappropriately touch them it feels shame and guilt" although it is hard to open up but have seen in many cases that when they inform the caregivers they do not support. Similarly reported by another participant "that she feels helpless when she informed her family that perpetrator is a close family member they don't believe and indirectly support perpetrator". In collectivistic cultures, people do not accept such kind of sexual offense against family member in some cases the perpetrator are the breadwinners which restrict the family to open up against them for sexual assault.
On the other hand, victimizations lead to feelings of self-rejection and suicidal thoughts for instance revealed by the participant revealed that she did wrong and committed sin' so have no right to live". In our society brought up of children and adolescents are based on religious practices in which they develop a mindset of fear about sin. The perpetrator gets benefits from this mindset by threatening them that they are committing sin and disclosure will put them in trouble, therefore, adolescents start blaming themselves as if they are sinners. Another cultural component is obedience they are taught to say yes to the elders that's why unable to ask for support. Physical Abuse. Physical abuse is another worst form of abuse and neglect experienced by the participants in the study. Physical abuse is common in cultures either parents, teachers, caretakers, or guardians. Along with superordinate themes its emerging sub-themes are Harsh Disciplining, Dominance and Control, and Harmful Traditional Practices. Harsh Disciplining. Participants identified several concerns about harsh discipline practices by parents and teachers. Participants revealed caretakers use several ways to discipline for instance slapping scolding, pushing, and hitting with a stick. Harsh disciplining puts them into consistent fear of being punished revealed by the participant that "he feels scared in the presence of parents for unexpected hitting". As a result, they do not feel encouraged to ask questions about their positive growth and queries. Participants also described "that strict environment at school and home never let them express their feelings with parents' friendly and hesitate in their presence". Violence toward adolescents was revealed by every participant such as "Parents were so much cruel to her and physically tortured as if she is not their daughter". Dominance and Control. Dominating and controlling is another emerging sub-theme. This practice with adolescents intensifies violence against them by not giving them independence and violating the right to be protected from any harm. Participant revealed, "she feels scared of being disclosed in front of her parents she stated that it is better to kill myself instead of facing her parents" for I am helpless and disclosure can worsen my parents towards me" fear of parental controlling leads to repressing feelings one of the participants described that "I am hesitating to share my feelings with parents" In culture parental and teacher's role as dominant, superior and controlling is acceptable but keeps adolescents unexpressed. Harmful Traditional Practices. Adolescents described several aspects of physical harming, hitting, and punishment all participants revealed they face harmful practices by caretakers, relatives, perpetrators, and school teachers. Harmful traditional practices are collectivistic based on specific cultural norms which are culturally acceptable but harmful for the adolescent. One of the participants described that "adolescents stay in constant tension and feel rejected when relatives and parents physically harm them, particularly when children disobey them" Participants revealed that "teachers should use kind teaching methods but they use severe punishments as if long-standing, raising hands" slapping and stabbing". On the other hand, the harmful traditional practice of gender discrimination still exists in the majority of boys who are valued over girls culturally. Boys have been given freedom, autonomy, and care whereas girls are discriminated against based on their gender.
Harmful practices to discipline adolescents, caretakers don't consider their right to an opinion, autonomy, and the best interest. The majority is unknown about mental health's negative long-term consequences of harmful traditional practices. Furthermore, parenting practices are more or less the same around all provinces of Pakistan which also contributes to increasing child abuse and neglect and its related mental health problems in adolescents.

DISCUSSION
Findings related to conceptualizing the forms of abuse and neglect in culture adolescents revealed forms of abuse and neglect are sexual and physical. Adolescents under 18 are at the risk of abuse and neglect adolescents suffering from all types of maltreatment physical, emotional, and sexual (Russel et al., 2020). This is factual harm to the adolescents' physical, and mental health survival, development, and dignity. (Chen & Chen, 2020). It is estimated that 90% of the perpetrator is known to the victim in this study here adolescent girls presented sexual abuse along with emotional threats and physical torture for not disclosing sexual assault (Guggisberg et al., 2021). Therefore Sexual abuse is interlinked with emotional threats, physical torture, and blackmailing.
While reporting sexual abuse it was evident that adolescents who face sexual abuse are prone to self-harm, low self-esteem, and suicidal ideation (Okunlola et al., 2021). Develop feelings of revenge against caretakers or others (WHO, 2021). Self-harmed risky behavior is common with a history of sexual abuse (Joleby et al, 2020). This led to pain, guilt, shame, emotional and mental harm, sexually transmitted diseases, brain impairment, and interpersonal difficulties (Gupta et al., 2020). In the long run past adverse experiences led to severe psychiatric disorders such as post-traumatic stress disorder (Kalmakis & Chandler, 2015).
Although sexual abuse against adolescents is a global issue universally there are several supporting programs accessible for adolescents to report. Pakistani culture at first denied accepting sexual abuse. Secondly fear of stigmatization doesn't let them speak, the justice system is timeconsuming as well as weak, economical dependence on key stakeholders does not let them stand against perpetrators and lack of awareness is the key component not to disclose and suffer silently.
Adolescents also presented physical abuse such as harsh discipline practices, dominance, and control, harmful practices causing them to repress feelings and emotions, cannot communicate their problems, stays under pressure, and are frightened of punishment (Afifi et al., 2020). Physical violence goes along with harsh discipline practices that culturally physical punishments to discipline children are acceptable for parents despite knowing the perceptions of adolescents in it (Cui & Lan, 2020).
To prevent abuse and neglect against children and adolescents global attention is required. Urgent stakeout is required to endorse United Nations 2030 sustainable Development Agenda for Asia. Moreover, sensitive safety measures are also required in Asian countries where nearly half of them are experiencing abuse and neglect between the ages of 2-17 years (Hillis et al., 2019).

Counseling Implications and Conclusion
Intervention in the area of abuse and neglect required attention to address this escalating issue particularly to reduce its long-term impact on adolescents' mental health. For systematic management, early identification, prevention, awareness, and rehabilitation are needed. Government officials refine their role in safeguarding policies and implementations on child rights. Parenting and teaching practices needed to be revised to identify gaps as well as to break the silence for justice. Specific effective counseling interventions and training are required for counselors.

Limitations and Future Directions
This continues at the dire need to explore further hidden cultural forms of abuse, especially in adolescents, young adults, and children.