Its very clear that someone else controls the screw-driver, not the child with the mask. The mask that breaks out of the silence is the mask with the mouth wide open. The secret is out. It is an empowered mask. It is also a very frightening mask.
People find attraction and repulsion in that image.
It is not a pleasant image. There is clearly a struggle in this recovery from pain. The mask helps us to look at the pain, to give it a form and to give it a voice. So often in child sexual abuse the problems are the things that come out sideways. Healing is about looking at these masks as the source for that healing.