Child Abuse: Observations from a Retired Pediatrician

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child abuse
Since the title of this blog is “Hormones Matter” a reader might well ask why I am addressing the subject of child abuse. In all my posts I have tried to show that normal brain activity depends on normal energy metabolism induced by efficient oxidation.  It is obvious that child abuse can be simply a lack of love and we know that people are capable of cruelty but I have had an unusual experience with child abuse. The nature of the extreme cruelty is hard to explain as coming from a parent with a normal brain function. I am going to recount the history of three unusual cases. They were so awful that it resulted in a symposium at Cleveland Clinic Foundation where every member of the many public organizations in the city dealing with children’s welfare were invited.  Many years later, I met a woman that told me that it had led to the establishment of the “hotline” that operates in Cleveland today. They all happened so many years ago that identification would be impossible.

Perhaps the most tragic case was Charlie who was brought for medical consultation “to explain all those scars on his body”. The point is that the correct nature of the cause of the injuries is never given. It is “this strange disease” or “he fell off a wall” etc. So a physician has to be a detective as well as a sympathetic listener. It turned out that the real cause of Charlie’s scars was repeated cigarette burns perpetrated by his mother. This has been reported in other cases. I imagine that it is “you do that again and I will punish you with another burn!”  It comes from the mind of a parent under extreme stress, especially as the father had the nickname, “Killer”.

Then there was Vicki, aged four, who was admitted to the hospital with an obvious case of Kwashiorkor, the typical appearance of protein starvation seen today in children of third world countries. Vicki quickly began to flourish, even with hospital food and it turned out that it was a case of attempted homicidal starvation. Although this could not be proved, the mother was ordered to appear with the child at regular intervals. Each time that she made an appearance the child was clothed in a new outfit, each one being of a different color. One day the child appeared with three bruises on her forehead and this was explained by a fall. I must add here that all this was before the Child Abuse law was established in Ohio. At that time it was necessary only to report a suspicion to the police. Later, Vicki was brought into the emergency room in coma and was passed immediately to neurosurgery where the brain tissue was found to be abnormal in appearance and substance. When she died, nothing could be proved but I suspect that she was smothered.

The last case I want to describe was a 6-month old infant referred by a pediatrician who had found an enlarged liver in the child. He was scheduled for liver biopsy but with TLC from the nurses he began to sit up by himself for the first time and to my great surprise, I found that the enlarged liver could no longer be felt. I cancelled the biopsy and told the mother what the findings were and that she would need to follow up with the pediatrician. As I was reporting to her, there was a sudden and dramatic dilatation of her pupils. I became suspicious that she was on the verge of a nervous breakdown and wrote to the pediatrician asking him to watch out for possible child abuse. The mother was referred to a psychiatrist who reported that she was perfectly normal. A month or two later, this child was in an emergency room with a skull fracture, still accepted as “an accident”. The next event proved the underlying truth when the child was found drowned in a bath tub. I later received a letter from the pediatrician telling me of the final event and adding, “I wonder how we could have prevented this?” I was unable to explain how something as important to an infant as TLC could rapidly lead to a return of an enlarged liver to normal. It did, however, lead me toward the importance of “mind over matter” in consideration of health and disease. Had the simple charm of loving care turned on the placebo effect?

Doctors are trained to accept the complaints of a patient and at this relatively early era in mid 20th century, child abuse was not as well known as it is today. Other pediatricians thought that I was cruel and unsympathetic, reflected by the presence of only three or four pediatricians at the symposium.

I have suggested in previous articles and papers that murder can occur in blind rage (seeing red), even on the spur of the moment. A crime can be accepted in Ohio as “temporary insanity” if it can be proved that the criminal “knows what he is doing but is powerless to stop himself from doing it”. This, totally different from cold blooded planned crime, was illustrated very well by Dostoyevsky in his novel, “Crime and Punishment”. The trouble is that it is virtually impossible to prove. In the case of child abuse, the abusive actions often occur impulsively and seem to be well beyond the powers of reason. The extraordinary love of motherhood is an icon of human behavior. I hypothesize that the brain of an abusing parent is biochemically abnormal and the child, in some way, irritates her/him to release a physical action known to be wrong, but beyond the power of reason. Although child abusers, like wife abusers, are more commonly from the lower socioeconomic members of society, it is certainly not confined to them. Alcohol and/or poor diet may well enter the picture in many cases, thus introducing biochemical changes that cause excessive irritability that overwhelms the power of reason. For this to be explored and researched, it would be necessary to accept the possibility. Our society and our medical thinking is very far from that.

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2 Comments

  1. I’ve been a teacher, gang-prevention community liaison, social worker for developmentally disabled adults, for homeless and re-entry adults and with foster youth. I’ve worked in refugee centers in El Paso and Juarez during the dirty American wars against El Salvador, Guatemala, and the like. I also most recently worked with DHS/CPS as a social worker helping foster youth navigate several rails to the train leading to their own hells.

    Amazingly, many overcome these hurdles, these abuses, these addictions — given drug courts and progressive thinkers give them second-third-fourth chances!

    https://www.laprogressive.com/drug-court/

    Hands down, the people I helped over the years with with criminal records, drug addiction and homelessness have had terrible experiences with parents and guardians who abused them — sexually, and with plying them with drugs. At very young ages!

    Really, hardened former gang members, opening up to me about formative years being sexually assaulted by an uncle or family friend. Age nine, ten, eleven.

    Untold amounts of parental fighting, violence, prostituting parents, drug use and drug sales by the adults in their lives. It’s absolutely amazing to me, even at age 60, that these people have survived, albeit on the streets, breaking laws and running the neighborhoods.

    That being said, not all my foster youth who were taken out of their parent(s)’s homes were in the above situations, and hands down, many foster youth I have worked with think the system against them seeing birth parents and biological siblings is more than pernicious. I agree.

    The entire landscape of damaged people, from a formative age, is expanding, as we have a more and more punishment mentality, in a society that says once you do your time for the crimes, the system will continue to beat you up — legal financial obligations, restrictions on work, restrictions on where you can live, and on and on.

    In a punishment society, one where the criminal justice system is unjust, we have a long-long way to go in healing as a society.When housing criminals is a for-profit Wall Street traded business, the results are the same as for-profit medicine.

    I write about this, what I call the punishment capitalist society, all the time. Here:

    http://bozzimedia.com/debtors-prison-not-tale-charles-dickens-lfos-punishment-long-time-served/

    It’s a true epigentic hell that is created on the backs of innocents, and drug addiction is one of the huge under girders to it all!

    https://www.laprogressive.com/heroin-anonymous/

    Thanks for your article!

  2. Wow ok lets clear the air at the door: child abuse is abhorrent. That being said, even with all the new laws and cps funding, severe child abuse is not being caught while parents of children with genuine medical problems are having their children snatched away from them because either they dare to ask for a second or third opinion, or because the doctor cant even make a proper diagnosis while a child wastes away. Doctors, teachers, public employees of all sorts are required (at least in texas) to report suspected child abuse of any kind to cps immediately. So now we have an overtaxed system of children who would be better served with in-home care but instead are being emotionally, physically, or sexually assaulted by other children or foster/adoptive parents, while children who really should be taken from the home are left to suffer. The extremely abusive parents, the ones whose children should be removed from the home, hide too well, while normal, stressed out parents who could use a leg up in a few places in their lives are seen as hostile because they are not (usually) sociopaths. Sociopaths hide. Theyve spent their entire lives hiding, putting on a happy face for their own abusers. You can say any number of things collude to create an abusive parent but almost always, it boils down to poor stress management due to surviving childhood abuse themselves (i am NOT trying to discount the articles concerns over nutrition, etc., but even excellent nutrition will not teach a person how to handle incredibly stressful situations). So, doctors are incapable of properly diagnosing both disease and abuse, yet, by law, they are required to report abuse, not to the police, but to cps. Cps has been infiltrated by a number of sociopaths who play the hero in their own twisted movie, the court set up for cps is a kangaroo court, where the predominantly poor and underserved of our communities are bullied into wasting tax payer dollars on services they dont need while not getting the services they do need. Compounded by the fact that once cps gets involved any sort of counseling is immediately seen by many as a way for cps to get ammunition against the parents and usually is. The incompetent twits on cps payroll are literally showing up for a fat check and dont care about you or your kids. What can we do? Cps is funded by government grants. This is an organisation that wants to spend money not save money (for a bigger grant next year) so they will remove children from easy targets (read: poor), send the parents to subpar “services”, pill dispensaries, and incompetent mental health “professionals”. What if we spent that money on middle school and high school programs, making parenting and stress management required courses in schools? What if we showed students the various types of abuse, have parents who were taught better stress management after their own abuses talk to students about what happens to child abuse survivors? Not only would this lead to a sense of empowerment for children of abuse, being able to not only identify but report actual abuse, it would also drastically reduce abuse cases. If done right this should also curb the strain on the cps system, allowing it to properly allocate its resources to more than just “neglect” because a house is dirty. The system is failing our communities, our parents, our children. We live in a world where a little white pill will fix everything. Except it doesnt. How many mothers on antipsychotics have drowned their children because instead of cbt they were given a little white pill? Our entire system is corrupt. All attempts to fix it have made it worse. I am left with the belief that they dont want it to be fixed. And we all suffer for it.

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