Child Abuse

Introduction

This paper will attempt to review my course of study regarding the definition, assessment, treatment, effects, and prevention practices surrounding the issue of child abuse and neglect. Individually, these studies are complex, as there are significant cultural, social, and psychological components to each, and a full treatment would necessitate a work of several hundred pages. I will attempt in a generic way, therefore, to provide some basic understanding as to my learning regarding each of these areas, and my current thinking about the issue of child abuse and neglect in today’s society.

Definition

Child abuse, as defined by the California Penal Code, Sections 11161.5 and 273a, is the omission or commission of any act, by any person, which causes physical injury or injuries that appear to have been inflicted upon a minor by other than accidental means. Such acts include: sexually molesting a child; willfully causing or permitting a child to suffer; inflicting on a child unjustifiable physical pain or mental suffering; and with respect to persons having care or custody of the child, willfully causing or permitting the health of a child to be injured, or willfully causing or permitting the child to be placed in a situation that is such that the person or health of the child is endangered.

Physical abuse, sexual abuse, and negligence are by far the most predominantly recognized forms of child abuse. Emotional abuse is discretionary, except for willfully cruel and unjustifiable infliction of mental suffering. The definition of physical abuse occurs wherein “injury is inflicted by other than accidental means on a child by another person.” Sexual abuse means “the sexual assault of a child by any act or omission.” Neglectful abuse means “negligent treatment or maltreatment of a child, or failure of a person having caring for a child to permit the health of the child to become endangered, including failure to provide adequate food, clothing, shelter, or supervision.”

Additionally, Wecht and Larkin (1982) have defined four distinct types of abusive parents:

1. the parent who alternates abuse with proper care;
2. the one-time abuser who either restrains himself or kills the child;
3. the constant abuser who hates the child;
4. the ignorant abuser who doesn’t know any better way of bringing up the child.

History

Perhaps one of the reasons why child abuse and neglect is such a relatively new topic of interest is the abominable record the human race has had concerning its young. This is not to say that different civilizations through the ages haven’t had laws concerning the parent-child relationship. Historically, however, the laws favored the parent.

The Hammurabi code, for example, dates back to 2150 B.C., and is one of the earliest known set of statutes. In this Code, the father had life-or-death power over the child, and infanticide was acceptable. The parents owed the child the minimum required to keep the child alive, as long as the child was respectful. If not, the parents owed the child nothing. Disrespectful children were dealt with harshly; a child who struck his parent could have both hands cut off, and the child who talked back could have his eyes and tongue removed. The child could also be given to another person to work off the parents’ debt.

The Romans (750 B.C. to 560 A.D.) had similar laws, but in some cases, they were even harsher. Infanticide was still practiced, as was the selling of children to satisfy debts. However, under the Hammurabi code, the child sold in such a fashion would be returned to its family after three years. Under Roman law, the child never reverted back to the original family.

The Visigothic code (470 A.D. to 710 A.D.) represented a major advance for the rights of the child. A child could no longer be considered chattel to be bought, sold, or pledged. He was also given statutory rights to life and to the property of his parents’ estate.

Early English law (1300 to 1600 A.D.) reflected more of the Roman legal viewpoint than the Visigothic. Infanticide was condoned within a certain time period, and children could be sold if the parents were poverty-stricken. In 1601, the Elizabethan Poor Laws were passed, which allowed the children of poor families to be taken from their homes and put to work or apprenticed. This system was then replaced by government-run workhouses. In 1760, the Pauper Apprentice System allowed children from poor families to be exploited in factories. Later, the Factory Acts saved orphans from this fate but did nothing for those children still in the custody of their parents. A great step towards reducing the manipulation of the child by the parents was taken in 1833 with the enactment of the Reform Law, which limited the work week to 48 hours for children between 9 and 13 years of age, and to 68 hours for those from 13 to 18 years of age. However, the practice of infanticide continued unabated.

Early American law followed in the footsteps of Roman and English laws regarding children. The Massachusetts Stubborn Child Act of 1628 specified that children who talked back or disobeyed would be put to death.

The case that finally turned around the prevailing view on children was the 1862 case of nine-year-old Mary Ellen. After being stymied in their efforts to obtain legal relief for the abused Mary Ellen, church workers appealed to the Society for the Prevention of Cruelty to Animals, who took the case on the grounds that Mary Ellen should have at least the same rights as an animal. They won the case, and within 30 years every state had enacted laws protecting children. By the turn of the century, the Juvenile Courts had been set up to provide safety and treatment for child offenders.

Beginnings

Head x-rays of abused children lead Caffey in 1946 to speculate on the existence of some sort of disease as the cause. It was not until 1962, however, when Kempe published an article on the “battered child syndrome,” that health professionals, governmental agencies, and the general public began to take notice of the problem. By 1963, the move was afoot to pass legislation governing child abuse, and soon all 50 states had mandatory reporting laws.

Current Status

Estimates of the incidence of child abuse and neglect range from thousands of cases to millions of cases. Better estimates are elusive due to the lack of standard definitions of child abuse, varying sources of statistics, and the discrepancy between the number of actual cases and the number of cases reported. Recent studies suggest that 1 to 1½ percent of children in the United States are victims of abuse and neglect, for a total of nearly 900,000 incidents. Even if the true figures were proven to be much lower, child abuse and neglect would still be a serious problem.

The studies also show that white children in low-income families are most at risk. Incidents of abuse and neglect increase in step with the age of the child, and the parent or parent-surrogate is the most likely perpetrator. Sex of the child and size of the family are less determinant, according to the studies.

Assessment: The Child

The process to assess whether or not a child has been legally abused or neglected is a lengthy one and involves a great many professionals in the community. Professionals trained in child abuse from the department of children’s protective services, the police department, scan teams in hospitals, and many other multi-disciplinary professionals and para-professionals provide reports to the Juvenile Court system for judges to ascertain whether or not abuse has indeed occurred. In the case of physical abuse, the assessment of whether or not legal abuse has occurred is based on the presentation of actual physical evidence discovered by and reported to appropriate professionals in the community. The assessment of sexual abuse includes a physical examination of the suspected victim, a report from the suspected victim, interviews with the victim’s significant others, interviews with the suspected abuser, and oftentimes a psychological evaluation by a court-appointed psychologist trained in the assessment of child abuse. The assessment of neglectful abuse is generally based on the appearance of the child, the appearance of the home setting, the health of the child, or the discovery of the child left improperly attended or without adult supervision.

Assessment: The Parent

Two more aspects of the assessment process include identifying the factors that are common to abusers and identifying the personality characteristics of abusers.

Factors

Various studies have indicated that there are fourteen basic factors that can lead parents to become abusers:

1. they were themselves abused as children;
2. they have poor parenting skills;
3. they need emotional satisfaction;
4. there is some precipitating event in their lives;
5. they have unrealistic expectations of their children;
6. they are socially isolated;
7. they have an emotionally unsupportive marriage;
8. they are deficient in social skills;
9. they want the child to be emotionally supportive (role reversal);
10. they view their children as evil monsters;
11. they don’t understand the child’s needs;
12. they don’t recognize normal child behavior;
13. they believe in physical punishment;
14. they view the child as their property.

Personality Characteristics

Because of the wealth of personality characteristics that have been noted in abusers, some researchers have hoped to formulate a typology of an abuser to aid in diagnosis, treatment, and prevention of child abuse. These include:

• excessive guilt;
• chronic depression;
• high levels of anxiety;
• coolness and detachment;
• rigidity;
• character and personality disorders;
• schizophrenia and other psychopathologies;
• chronic aggression;
• violent impulses;
• immaturity;
• low self-esteem;
• low frustration tolerance;
• impaired impulse control;
• substance abuse (usually alcohol).

General goals of the assessment process include:

• joining and supporting the parents in their difficulties;
• obtaining the adults’ permission to discuss them and their children’s situation with all other professionals involved in their case;
• obtaining a complete history of each parent, their parents, and their children from birth to present, including medical, psychological, and educational background; and
• ascertaining the clinical needs of this family and how best to “treat” them.

Reporting Requirements

Any professional having suspicion that abuse has occurred is mandated by law to report by telephone immediately or as soon as possible to law enforcement or children’s services offices, and to send a written report of the incident to the proper authorities within 36 hours. Any other person may also report known or suspected incidences of child abuse and neglect and may do so anonymously. When a professional makes a report, the professional must include the name of the person making the report, the name of the child, the location of the child, the nature and extent of the injury, and any other information relevant to the incident. The psychotherapist-patient privilege does not apply to incidents of child abuse in any court proceedings or administrative hearings. However, the identity of all persons who report is kept confidential and disclosed among child protective agencies only by court order, or when needed for specific court action. Law enforcement agencies and children’s protective services are required to report to one another incidents of child abuse as they come to their attention by telephone immediately, or as soon as possible, and to send a written report within 36 hours.

Anyone may report a suspected incident of child abuse by contacting their local police department or children’s service workers’ office, or by calling the special hotline number, ZENITH 2-1234, to report a suspected incident of child abuse. This report begins the assessment process previously discussed to ascertain whether or not abuse has occurred.

Etiology

Of the many theories developed to explain the reasons why child abuse and neglect occur, I will focus on the five that have received the greatest attention: psychoanalytic, attachment, social learning, environmental stress, and family systems.

Psychoanalytic. Psychoanalytic theories postulate that psychopathology, personality characteristics, and internal conflicts cause people to become child abusers.

Attachment. Poor or non-existent attachment between the mother and the child has also been blamed for child abuse. This dysfunctional attachment may take the form of premature separation, quarantine due to illness, or stressful life situations.

Social Learning. Research indicates that a large percentage of child abusers come from violent and abusive homes. Social learning therapists claim that these statistics provide support for the theory that child abuse is a learned behavior.

Sociology. Sociologists emphasize stress-producing environmental factors as important components in the incidence of child abuse.

Family Systems. Child abuse is considered a symptom of deeper family problems by family systems therapists. These deeper problems create the need for a homeostatic device to stabilize the family and to provide a status quo, and this device can be child abuse. Therapists note that families with child abuse problems tend to share certain characteristics, such as a closed family system, a family scapegoat, and a disorganized family structure, among others.

With the wide variety of research results, it is unlikely that one theory of child abuse will ever be adopted to the exclusion of the others. This view is reflected in the DSM-III, which does not include child abuse as a category because “child abuse as an act can be a symptom of many different disorders” (1980).

Treatment

The abuser, the abused child, and the extended family will all be in need of psychological help, so treatment techniques that deal with the entire family are an essential part of dealing constructively with child abuse.

The most immediate consideration is of the welfare of the child. It must be ascertained that the child is no longer threatened. Next, a home must be found for the child. In some cases, the child can be returned to his own home, but in others, the child must be placed in a foster or group home. Once placed, the focus is on attending to the medical, emotional, developmental, and psychological needs of the child.

Treatment for the parents is most effective in the long run when they are assisted in feeling better about themselves. When their basic emotional needs for love, self-respect, and competence are satisfied, they are less likely to mistreat their children. Treatment for abusive parents is primarily a process of reparenting. Parents need someone who can be there in times of crisis and who can help them with their practical needs by leading them to resources or by providing more direct help. They need assistance in learning how to manage their own lives and help in understanding their child’s needs.

There are currently a variety of treatment programs available for these families. Parents Anonymous (physical abuse and neglect), Parents Limited (sexual abuse), Family Shelters, non-profit private facilities, and county-funded counseling centers provide programs ranging from parenting classes to individual adult/child psychotherapy for these needy families. Never more than now are these community resources available to provide multi-faceted treatment, including child care, housing, food, clothing, job training, parenting, family therapy, group therapy, support groups, and individual treatment.

Prevention

Professionals involved in this area have increasingly turned to training programs in hopes of helping to prevent child abuse. In Los Angeles County, the Los Angeles Unified School District has implemented a district-wide identification and prevention program for its teachers to attend. The California Department of Social Services and the County of Los Angeles are beginning to fund state-wide programs primarily focussed on developing prevention strategies regarding child abuse. The private sector is also responding to this need. It has become apparent that given the stresses of adult life in today’s society, parenting is no longer viewed as a simple or easy responsibility. Where once it was commonly held that to parent was natural, it is now clear that successful parenting requires a complexity of skills. The reports of thousands of cases of suspected child abuse make it obvious that parents are sadly deficient in these skills. Because of this, we must develop the means of properly educating, supporting, and socializing parents. The teaching of these skills must also be included in any rehabilitation program for incarcerated child abusers.

In the past decade, we have defined the problem, and inroads are being made in the area of remediation. However, persuasive, effective prevention remains a distant goal.

Summary

The fact that it took so long for medical and mental health professionals to recognize child abuse led me to speculate as to why. First, I feel that many therapists want to deny that abuse exists because it is uncomfortable to consider or confront. Second, I feel that some therapists believe that labeling a family as being abusive would stigmatize them, damaging the therapeutic alliance.

Working with cases of child abuse is a tremendous challenge for the family therapist. All forms of family therapy view the entire family as the “patient,” which of course must also be done in cases of child abuse. However, added to the mental anguish (and sometimes the mental cruelty) found in other dysfunctional family systems is the element of physical abuse, which may include sexual abuse. This physical side of the problem intensifies and deepens the emotional and psychological problems of the family.

Abusive families must also be handled differently than the usual cases one encounters in therapy in that dealing with the here-and-now is often not enough to change the behavior. By the time a person is old enough to become a child abuser, he or she has been living with pain and confusion for years. Because of this, the therapist is forced to “play catch-up” by working on the past before progress is possible in the present.

Professional Insights

The more I studied child abuse, the more I felt drawn to help these families. I found that not only do I empathize with the children, but I also empathize with the parents, many of whom were abused themselves when they were young. As I grew to understand that many parents don’t want to abuse their children, the long-term effects of treatment became more meaningful. I realized that through helping abusive parents, I am also helping the child, and this helps me feel that even under the worst circumstances one can work from a hopeful position rather than a hopeless one. I feel very optimistic about my ability to continue to help parents learn to deal more effectively with their children.

In talking with other therapists, I have found that not all of them share this view. Some of them over-identify with the child, and some experience a great deal of counter-transference. This leads them to avoid child abuse cases. In my work, I find that reparenting members of abusive families so they can experience caring and love can be extremely gratifying.

Another issue I find significant is that of treating the dynamic of the abused child that identifies with the abuser. This occurs because children want parental love so much that they begin to equate abuse and love, and therefore they keep reaching for love and internalizing the feeling that a painful experience is part of love. This identification is also a self-protective device to attempt to get the aggressor to be agreeable and friendly. An example of this is that children who are being bullied in school will make every effort to become the bully’s friend (giving food, money, prized possessions) in order to stop the aggressive behavior towards them, in spite of their feelings of great anger and fear towards this person. It has been found that they make the effort to identify with the bully in the hopes that the bully will identify with them, thus sparing them from further terror. When I work with abused children, I always attempt to deal with this dynamic, because I feel this is a pertinent clue that helps explain the masochistic tendencies one sees in individuals who stay in bad relationships. Children have little choice in staying with an abusing parent, however, when adults tend to be in masochistic relationships, one can assume that they must be associating pleasure with pain and that feeling undeserving is a part of being loved.

References

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