Preventive Measures......................................................................................

In The Medical Field
 
 

FACTORS WHICH ADD TO STRESS

     In addition to the main predisposing factors, others can have an effect on background stress. Some of these factors are: the intelligence of the parents, the state of their health, their socioeconomic status, cultural background, and psychological make-up. The handicap of very low intelligence makes it difficult to cope independently in a competitive society. And parents need to have knowledge and good judgment to care for young, helpless children. A parent's lack of ability, combined with emotional difficulty and impulsiveness, places the child in danger.

     A mentally slow mother of four children took in her boyfriend. He beat her and abused her children severely. "She was so intimidated by his threats that she was afraid to go to the authorities, but was relieved when, after six weeks of abuse, her mother did."

     "Chronic illness may make it difficult to provide economic or even physical care for a child." If either of the parents or the child is always sick, it's all that much more work for parents. It's automatically a big responsibility to raise a child properly. And it does take work. Taking care of someone who is always sick can create that much more of a toll. The parents can become impatient, tempers can flare, something can "snap inside them" and control can be lost.

     "When a parent's cultural background is very different from that of the community in general, this can naturally lead to a feeling of estrangement." The simple fact of isolation - living in a very rural area - may make one cling even more to the old values. Some see their loss as a threat to one's very identity. At times, the cultural values include child-care practices which are unaccepted here in America. Such parents may resent outside interference. Strongly resisting any attempt to change their ways, they consider interlopers as being invasive of their privacy and of their very heritage.    [76.]

     There are various facts and conditions of everyday life which can undeniably contribute to lifelong patterns of failure. The enervating effect of continuous poverty and the helpless frustration of social discrimination are specific examples of these.

     Among two-parent families, there is usually one parent who is the active abuser. He or she either abuses or in some form or another more strikingly neglects the child. Generally, the other parent acts as an accessory by arranging for, condoning, encouraging, or covering up the abuse and neglect.

     Child abuse occurs in the presence of four main factors. We've examined three:  (1) the parents must have a background of emotional or physical deprivation, which may include abuse as well;  (2)  a child must be seen as unlovable or disappointing; (3)  there must be a crisis.

     The fourth predominantly significant factor is that no effective "lifeline" exists. There is no line of open communication to sources of aid at the moment of crisis. This fourth factor is most important. Lifelines are essential to all of us: to be able to call for help in times of dire need. Abusive parents cannot rely on each other for rescue in moments of crisis. Outside lines have to be developed quickly while the parents are undergoing treatment. What is clear is that one cannot easily change parents' emotional backgrounds. Neither is there a magical cure for their twenty-year histories of deprivation; nor can one help them to see their children as lovable. However, one can provide for rescue of the children, relief of the parent or parents, and the beginning of crisis management.
 
 

WHY SOME PARENTS BECOME ABUSIVE

     "Behavior of the adult - angry, indifferent, seductive - can vary tremendously. Attaching blame to these parents may be difficult to resist. But it is more useful to view their behavior as an extreme response to stress, and often these parents themselves are suffering individuals who endured abused childhoods. One of the major misconceptions about abusive parents is that they are invariably disadvantaged. Poor parents may well be under more external stress from worries about homelessness, overcrowding, or debt than those who are better off, but the crucial internal factors are remarkably similar for rich and poor parents alike. Another misconception is that abusive parents are fundamentally and incurably abnormal, psychotic, criminal, or retarded. Like the first, this conception is probably popular because it tends to put a distance between us and them.

     "A third misconception about child abuse is that it is very rare. In fact, child abuse is reported 320 times per million population. Reported sexual abuse stands at 150 per million. Since the dimensions of the problem elude precise definition, it is not surprising that disagreements arise concerning the incidence of abuse. Our evidence shows that reported cases represent only a fraction of the total (sexual abuse, especially, is underreported). Investigators who base their conclusions only on reported cases inevitably underestimate the problem. David Gil, for instance, states that 'the physical consequences of child abuse do not seem to be very serious in the aggregate.' It must be stressed, however, that all of Gil's data from 1965 to 1969 were taken from reported cases only and were collected in the earliest years of the laws mandating reports of abuse."    [77.]
 

THE ABUSED CHILD
 

     Children vary just as parents do. Even within the same family children differ greatly. "Each child has his own unique significance for his parents: he may be their first experience of parenthood, or he may perhaps arrive handicapped in dreadful contrast to a healthy firstborn.

     "Sometimes in the first few moments after birth the baby's sex, or some aspect of his appearance, will produce in his mother a whole constellation of expectations about what he will mean to her." He may look like his paternal grandmother. Just because he has reddish hair like her, his mother may attribute to him all the critical meanness and selfishness of her mother-in-law. Once a notion like that is entertained, it can create a monster. It may  unconsciously reinforce the perception that the baby, when he cries, is also being critical and selfish. This isn't so  farfetched. Many a mother, seeing her son at birth, has sighed with obvious feeling, "He's just like his father - it's sickening!"

     Separation of the baby from the mother because of prematurity or illness creates further stress; or of the mother from the family through illness.

     There is a widely held belief that abused children or those failing to thrive are not lovable. Thinking this is the primary factor in the child-abuse equation. "Like so many other theories in child abuse and neglect, this one does account for some cases, but the family background has to be just right to make it an important consideration."

     "Ideally, a wanted child is regarded as lovable by both mother and father; they support each other and are delighted with their roles as parents. The baby quickly responds to cooing, stroking, cuddling, and talking, and at an early age forms very specific responses to father and mother and a different response to strangers. A baby who can meet his parents' needs, is undemanding, easy to care for, healthy, and to them attractive will add to the positive feelings they already have and increase their attachment to him - and vice versa. Many babies can even 'turn on' parents who, to start with, find them only mildly attractive. But some children are, right at birth, perceived by one parent or the other as simply so different from prior fantasy that their perfectly normal newborn behavior, such as soiling and crying, is regarded negatively, and no bond of love develops. And if the infant is premature, small for
gestational age, ill at birth, has some inherited defect that makes him imperfect, or is not cuddly but stiff and unresponsive, a relationship can develop that is the opposite of the ideal symbiosis. The child is a disappointment and is let known that he is. Whether he was 'lovable' or not in the first place, he quickly becomes to the parents a veritable monster, and bonding in hate may result.

     "Some children are genuinely difficult to care for, but receive the most loving, patient, and selfless care from their parents and siblings. There are children with obvious physical anomalies, such as hairlip and cleft palate, that interfere with simple feeding. There are seriously retarded children whose inability to smile, stiffness, or spasticity prevents them almost totally from providing the parents with the rewarding response needed to build and enhance a good relationship. At the birth of a defective child, the shock to the parents is always enormous and they go through a reaction of denial and grief and anger, but it is remarkable how many correctable and even not correctable serious congenital defects are accepted by families with compassion. Rearing a handicapped child is undeniably difficulty. These children may not seem very obviously lovable to strangers, but many are indeed loved, often fiercely, by their parents. Just as it is wrong to say that poverty itself or poor housing or unemployment is the cause of child abuse - ignoring the fact that many millions of poor people do not abuse their children although they live in conditions of deprivation - so it is wrong to assume that a child will be, even somehow deserves to be, abused or neglected because he cannot easily be loved. Many children become unlovable as a result of having had exceedingly little love offered to them, of having known a life of bare survival or utter hate. Their scars are deep at an early age.

     "Another very important factor needed to induce a bonding of love is the 'fit' between those characteristics of the baby usually called 'constitutional' and the imagined characteristics the parents were hoping for. An infant who is very placid, sucks efficiently, and sleeps most of the time between feedings is going to please almost any parent. But a baby who seems floppy and lackadaisical when nursing but becomes tense, irritable, and inconsolable when he should be falling asleep can be a trial to the most secure mother. T. Berry Brazelton's work has shown us that newborns' characteristics can be an indication of their adaptability in the early moments of life. Descriptions by Alexander Thomas and Stella Chess of various constitutional types also reinforce the view that babies do differ physiologically and cannot all be treated alike. This matters, since caring for a baby is a twenty-four-hour-a-day job, and the caregiver's resistance and patience do wear out. A baby who does not cuddle, but arches back and struggles, may upset one mother if she sees it as rejection, but not another, for whom it may be a sign of strength and independence - portent of a football star. Given the sensitivity of the potentially abusive parent to the early characteristics of his child, and his undue readiness to attach long-term significance to them, it is easy to see how the stage can be set for difficulty and how little outside stress may be needed to create the first small crisis."   [78.]

     Unrealistic expectations, coupled with the inability to live up to them and the ignorance and/or youth of the parents, can often set the stage for deadly "discipline." The "crimes" of their children? Playing with food in the refrigerator, splashing water in the toilet, touching the TV or stereo, talking back, wetting the bed, crying ... and a slew of other simple, harmless "violations." Often their punishment has been death. This is but one recurrent theme in the issue of child abuse - discipline to the death - inflicted by parents who are ignorant of the stages of child development. They have unrealistic notions about when children should know how to behave in certain situations and about how they should respond when their children do not meet these expectations.

     They begin to see the child as being uncooperative and even spiteful. They feel that the child is resisting them if, for instance, he is not completely toilet trained by the age of one, and he happens to have an "accident." The parent(s) thinks that if the child doesn't do what is expected and they think that it is not their fault, then it must be the child's fault. To offer an analogy, a pediatrician in the Child Abuse Program at Children's Hospital in Columbus, Ohio, Dr. Charles F. Johnson says, "You know, you see people kick the tire on their car when it doesn't start."

     Abusive adults are often socially isolated and feel like failures in most situations.

     Vladimir de Lissovoy, a child development professor at Pennsylvania State University, conducted a study of 48 couples who married while still in high school. His findings, which he termed disturbing, shouted that most had low tolerance and unrealistic expectations of their children. This contributes to their impatience with their offspring and to their sometimes cruel treatment of them. During a number of his visits to these households the parents freely discussed how they administered spankings to their babies for crying or other "misdeeds." On several occasions he even witnessed the punishments.   [79.]

     One theory as to why some adults (whether parents or not) become sexual abusers of children is that they are degenerates to begin with. This theory of the "abuser as degenerate" maintains that they are psychopathic, feeble-minded, physical and moral degenerates. It should be noted that this preconception has not withstood the test of time and light of evidence. These results came early on in the study of the child abuse phenomenon and were conducted using mostly prison inmate sexual offenders as the control groups. The findings were less than enlightening, showing that only a small portion of such sex offenders psychotic, senile, or mentally retarded. These studies painted the offender as being less repulsive than the run-of-the-mill criminal. They painted a more human, even sympathetic portrait of him.   [80.]

     Many molesters were viewed as men who as children had overly seductive mothers. Supposedly the mother's overtures aroused the incest anxiety in these men, which in turn spawned a fear of adult women and adult sexuality. They allegedly turned toward children for sex perceiving that a child does not present such a threat. Theories based on the Freudian model focused on early childhood sexual trauma as the source of this deviant behavior.

     Still other theories concur that the deviate's sexual preoccupation with children results from an unusual y pleasurable childhood sexual experience, whereby he becomes sexually fixated at an early developmental stage; conditioned to respond to that early childhood experience. It is contended that a negative sexual experience can have a similar effect in that it can deter the individual from normal sexual maturation, or drive him into a compulsive repetition of the original situation in an effort to change the outcome.