DEVELOPING DEFINITIONS
MEDICAL DEFINITIONS OF CHILD ABUSE: Medical definitions of child abuse first appeared in the medical journals in 1962 and have continued to expand and be modified since. The medical definitions of child abuse will be group into Physical Abuse, Physical Neglect, Emotional Abuse, Emotional Neglect, Sexual Abuse, and Sexual Neglect.
Physical AbusePhysical Abuse: the first medical definition of child abuse was formulated by Kempe and his associates in 1962. Kempe Et Al (1962) stated that child abuse was a "clinical condition in young children who have received serious Physical Abuse, generally from a parent of foster parent." Four years later Fontana (1966) expanded the definition to "the abuse and neglect of a child ranging from failure to thrive, malnutrition, poor skin hygiene, emotional deprivation, bruises, abrasions, and finally the obvious signs of the battered child. That same year the element of intent was added by Allan (1966) with the statement that abuse is "apparently purposeful, protracted, and periodic or persistent attempt to hurt an infant or child." In 1968 Terr and Watson added the concept of thoughtless behavior by stating that a "child’s injury or deformity may result not only from a willful act, but also from an act of careless on the part of the parent or guardian." Friedman’s (1976) contribution was the recognition of repeated trauma over time and the transmission of abuse from one generation to the next. Friedman (1976) concluded:
Child abuse is usually not a single assault but a continuing, ongoing trauma. It is characterized by a number of attacks over a period of time, steadily growing more physically and psychologically damaging, both in the severity of each attack and in the cumulative affects of the abuse. It is often conditioned behavior, learned from parent and passes from generation to generation. It is not limited to any economic or social group. (p. 97)
That same year Starbuck (1976) recognized that at the time the medical definitions of child abuse were inadequate when he stated:
There is no uniform definition of abuse… in establishing a concept that fits local needs, the broader the definition the better. I am of the opinion that the term "battered child syndrome" has nearly outlived its usefulness. It does not encompass the entire field of abuse or any of the neglect; it is frightening and should give way to such terms as "trauma X non-accidental injury (NAI), and inflicted injury". (p. 147)
Physical Neglect
Physical Neglect: little has been written detailing the behavior associated with Physical Neglect. Allan (1966) described neglect as "the omission of proper attention to a child-an omission that undermines his welfare". Steele (1976) provided a more detailed analysis of neglect, when he stated:
The term neglect has two very different meanings as it is used in this discussion. One is the common meaning of material neglect signifying a lack of adequate food, clothing, shelter, cleanliness, etc. Significant deprivation in these areas, particularly nutrition in the first two years of life, can lead to serious permanent deficits in general physical growth and in brain development. (p. 7)
Emotional Abuse
Emotional Abuse: emotional abuse occurs when a child is conditioned to believe that his body and/or thoughts are bad, wrong, sinful or dirty. This is most often done by indoctrinating a child with a phrases of "Quit the crying or I’ll really give you something to cry about" or "If you have a sinful thought, it’s the same as committing a sin, and you’ll go to the hell." These phrases teach a child to deny his or her need for warmth and affection. Using a child as a verbal punching bag. For examples: common with teen-age girls who have father with unresolved incestuous desires, is for the father to call his daughter a whore, slut, or tramp if she comes home late from a date. Additionally, expecting a child to accomplish tasks beyond his or her ability and then ridiculing the child for failure is Emotional Abuse.
Emotional Neglect
Emotional Neglect: Steele (1976) in discussing Physical Neglect and Emotional Neglect concluded: much more prevalent and important is the phenomenon of emotional neglect. By this term we refer to the situation in which the caretaker of the infant or small child provides less of the warm sensitive, interaction than is necessary for the child’s optimal healthy growth and development. Instead of being emphatically aware of the child’s state and needs and responding in appropriate fashion, the parent disregards the child’s condition and acts in ways primarily oriented toward parental needs and convenience. (p. 7)
In 1978, Whiting refined the concept of Emotional Neglect to include the refusal of parents to recognize or take action to ameliorate identified emotional disturbances of the child.
Sexual Abuse
Sexual Abuse: the definition of sexual abuse of children, outside of the obvious rape and traumatic physical exploitation, has generated much controversy. The apparent clash between professional as to what constitutes sexual abuse has been between definitions which rely upon cultural folkways, laws, and taboos and definitions that rely upon the biological needs of our species.
Demographics of Perpetrator
Historically speaking, relatives of child abuse victims were most often the identified perpetrators was the most common type case encountered and the most difficult with which to work. Cases involving penetration and fondling were the types most cited. Child victims in the early adolescent category (age 10-14) were the most prevalent (Thomas & Johnson, 1979.
Twenty male pedophilias were analyzed using the standardized personality inventory FP version A1 were dominated by signs of psychic inhibition and altered somatic wellness. Intelligence and education levels were usually low. Forty percent of convicted pedophilia has prior convictions of the sexual abuse of children aged below 14 years (Moller, 1995). Female victims are more likely to be molested by a close family member or a stranger, while males victims were more likely to be molested by perpetrators known to them, but not to members of the family. This supports other studies that suggest that the profile of perpetrators for males may be different, involving homosexual pedophiles that actively seek out and groom young victims. Research indicates that "as many as 30-50% of male rapists and child molesters have been molested as children" (Baker & Duncan, 1985).
Some professionals including those in the Department of Health, Education, and Welfare believe that any sexual behavior between an adult and a child is sexual abuse. The private sector is no different. Joye (1977) commented:
Sex is private thing. The child observing parents in sexual behavior is excusable once or twice if it occurs accidentally, but any more often or deliberate exposure by the parents is sexual abuse.
Thomas (1981) said that she told parents not to let their children see them in the nude. The puritanism of past history which made sexual behavior a sinful, bad, and dirty experience has now emerged again with abstract references to child sexual abuse only to perpetrate continued sexual repression.
Other professionals have stated that a child who witnesses sexual behavior between adults will not be harmed by the experience and in fact with benefit from observing their parents. McBride and Hardt (1975) stated:
In today’s confined living conditions it is inevitable that from time to time children witness their parents sexual behavior. If parents attempt to prevent this at all cost, by locking bedroom doors, for instance, or sending children away on some pretext or other, they create a situation of dishonesty and secrecy which impairs and trusting relationship between parents and children. (p. 153)
A well informed child will not be shocked to see his parents having sexual intercourse; to such a child sex is a positive sphere of life, determined by love and tenderness. (p. 154)
The controversy between biological sexual needs and moral-legal issues in regards to sexual abuse is a very difficult issue to resolve. In an article on sexual repression and its relationship to child abuse, Prescott (1977) stated:
Human sexuality is so powerful that its repression can make us kill the things we lost most. It can make us seek revenge upon a baby.
A variety of evidence strongly supports the view that physical pleasure inhibits physical violence. When we deprive our infants and children of physical affection, and when we are very repressive towards sexual pleasure, then the inevitable outcome is emotional disturbance and physical violence. (p. 98-99)
Cultures in which Death Worship religions dominate use sexual repression as a method to ensure the prevailing death Worship fantasy will have a pool of willing converts. Individuals who have been taught that their sexuality is bad are willing to accept fantasy instead of reality in order to define their self worth.
Often the abuse of teenage girls is sexual in nature. The typical drama is the teen-age girl coming home late from a date and the father attacks her by punching her in the breast often resulting in broken ribs. In psychodynamic analysis the father is acting out his own repressed sexual desire for his daughter. The family dynamics of the family most often are of a mother and father who have been alienated both sexually and emotionally from each other for years with the mother encouraging a close relationship between father and daughter. Both parents have been emotionally and sexually deprived for years. Their sexual repression had been a function of culturally approved sanctions and lack of sexual education. Sexual ignorance and repression precipitates sexual abuse. Berne (1964) calls this game uproar.
Sexual abuse is defined as anal, oral, or vaginal penetration; fondling; kissing or being forced to watch or engage in any type of sexual activity not considered appropriate. It includes nontouching sexual actions such as exposing oneself; showing pornography to a child; and photographing a child in sexual poses. "A substantial proportion of rapes among females are classified as child sexual abuse" (Tabachnick, 1997).
Sexual Neglect
Sexual Neglect: discussion of sexual neglects in the medical journals in sparse. Broadly defined sexual neglect would be the failure to provide a child with factual information on his/hers developing sexuality; about birth control and venereal disease, blocking accessibility to birth control; denying funds to provided to care for unwanted children.
In a study of teen-age pregnancy, Amburg (1977) reported:
We have an epidemic of teen-age pregnancy in this country… Over a million teenagers are pregnant… 600,000 under 17 years of age… 60,000 under 14. And if an unmarried teenager carries a pregnancy to term, 90% of her life script will be instantly written and that scenario is one of poverty, dependence, ignorance and hopelessness… and there is one other major problem area too… that’s child abuse. A new study in Seattle has brought up a direct correlation between unwanted pregnancy and child abuse… and child abuse is the number one killer of children under five. The Seattle study shows that the unmarried teenager who give birth to an unwanted child stands a 60% chance of beating that baby before its five years old. (p. 3)
Investigations of pregnant teenagers have revealed that 70 to 80% of them were not aware that coitus led to conception. Parents in the United stated have failed to educate their children regarding: coitus, pregnancy, birth control, abortion, and childbirth. The sexual education of most males has been one of "sow your wild oats, but marry a virgin" without any regard to their responsibility. The abdication of parental responsibility in sexual matters is a function of the parents’ own sexual repression which has crippled their ability to related to their children on sexual matters. The research evidence is clear. The vast majority of teenagers in the Untied States do not receive sex education in the home or in the school system. What sex education they do receive has been severely distorted by the sexual hysteria of their parents and teachers. The lack of meaningful sex education in the schools was printed out by Amburg (1877), when he stated:
In spite of the fact that 80% of all Americans with children of junior and senior high school age want sex education in the schools and providing of contraceptives to unmarried teenagers… 75% of the school districts with sex education in this country think teaching human reproduction and sexuality too controversial… and nit out of ten think discussions on birth control and abortion out of the question. (p. 4)
Sexual repression produces a psychopathology which makes the population extremely susceptible to advertising which alludes to sexual fulfillment when products such a cars, perfumes, drugs, jeans are purchases. Unfortunately, sexual repression also encourages child abuse and the suppression of sex education. The 1977 president’s Commission on Obscenity and Pornography concluded:
… That much of the problem regarding materials which depict explicit sexual activity stems from the inability and reluctance of people in our society to be open and direct in dealing with sexual matters. This most often manifests itself in the inhibition of talking openly and directly about sex. Professionals use highly technical language when they discuss sex; others of us escape by using euphemisms or by not talking about sex at all. Direct and open conversation about sex between parent and child is all too rare in our society.
When the 1977 President’s Commission report was presented to president Carter, he suppressed it saying that it did not represent the views of the majority of the American public and that the recommendation for the removal of Pornography laws would not be followed.
In reviewing the preceding definitions of child abuse, the gray area of what the definition of child abuse is depends upon the reporting parties’ bias. The Department of Health, Education and Welfare (1976) observed that:
Hazy distinctions between abuse and neglect can lead to problems in both reporting and case management. In some communities, for example, similar cases that are differently categorized as "abuse" or "neglect" are accorded quite different types of management.
New York City’s experience is that "the definitional distinction between neglect and abuse is often based on who reported the case… rather than what happened." The way a particular case is handled is often based on these very same superficial distinctions and labels. (DHEW#75-30073, 1976, p. 128)
Collection of information about child abuse has been impaired by the absence of an established baseline or symptomatically for nosology, and by the reluctance of mental health and health professionals to involve themselves in apparent cases of child abuse. Additionally, the development of a uniform definition of child abuse has been impeded by the social biases of the reporting party, law enforcement agencies, and social service agencies. Social bias has had a determining effect in establishing the right of a child for protection when his rights are conflict with parental or societal rights. Unlike disease which can be attributed to an invading organism or genetic predisposition, child abuse is a psychosocial disorder. Such a disorder is understood as a system of rewards and punishment based upon erroneous assumptions that are transmitted from one generation to the next, incorporating behavior patterns both classical and operant that are dysfunctional and often detrimental for the individual.
There has been no agreement in the differentiating between abusive and begin behavior among researchers. The disagreements among experts, be they individuals or agencies, on the characteristics of child abuse have extended to all aspects of it. Such uncertainties have resulted in contradictory and ad hoc responses in similar circumstances. These contradictions reflect the child rearing attitudes of the general public. Furthermore, Cultural and Societal Child Abuse have not been sufficiently defined legally or medically and are the most difficult forms of child abuse to define.
This concludes the discussion on medical definitions of child abuse. A review of the incidence of child abuse in the United States follows.
INCIDENCE OF CHILD ABUSE
INCIDENCE OF CHILD ABUSE: The incidence of child abuse in the United States is difficult to establish precisely. This mental health problem is of increasing gravity and is endemic in most large urban centers. Child abuse is not a new problem, but one-health professionals have only recently begun to gain some expertise in treating.
Assessing the actual incidence of child abuse is difficult because the reported rate has increased dramatically between 1968 and 1980. For example, Helfer and Kempe (1968) stated that every in the United States, approximately ten to twenty thousand children are killed, permanently disabled, severely injured and neglected by their parents, foster parents, adopted parents, siblings, baby sitters, or guardians. In a later study, Gelles (1975) estimated that perhaps a half-million children were abused by their custodian each year. The same year Hansen (1975) suggested that the actual incidence of child abuse is estimated to be ten times those that actually were identified and brought to the attention of welfare and law enforcement agencies. The apparent rise from 10,000 to 20,000 cases per year in 1968 to an estimated one million cases per year in 1975 is attributed to insufficient data on child abuse in 1968 and to increased awareness of child abuse by the public.
Between October, 1970 and October 1971, the central registry on child abuse for the state of Florida received seventeen reports. After a program was initiated to educate the public as to the procedures involved in reporting a case of child abuse, the number of reported cases jumped from seventeen in 1970-71, to 19,128 in 1971-72. In 1972-73, 29,686 cases were reported, and in 1973-74, 26,832 cases were reported (Dept. HEW, 1976; 75-30073). In a study on the incidence of child abuse in which twenty-nine states and territories participated, Vincent DeFrancis (1977) found that, in 1975, there were 289,837 reported child abuse cases, of which 136,505 cases were found to be valid.
Consistently in the literature is the acknowledgment that the incidence of child abuse is much higher than reported. The Department of Health, Education, and Welfare (Dept. HEW, 1976; 75-30073) stated, "child maltreatment has often been compared to an iceberg; reported cases account for the visible tip, but estimated suggest a staggering problem of proportions yet to be revealed." In noting the variables involved in the low rate of reporting child abuse, Lynch (1975) suggested:
While there has been a gradual increase in the number of reports of the cases of child abuse every years, failure to report is a major obstacle to providing protective services to abused children. It was estimated in 1973 that reports cover only one percent to ten percent of the total. (p. 142)
Lynch indicated that recognition of child abuse as a phenomenon in the older school child had been slow. He observed that there was a "relatively high incidence of child abuse in the school age population, a condition which was seriously under-reported and often gravely mishandled by school staff and that less than five percent of the nation's schools had reliable reporting procedures."
In conclusion, the actual incidence of Individual Child Abuse has not yet been established. Estimated incidence varies from 1,000,000 to 2,500,000 cases per year in the United States. Reluctance in the past by the general public and professionals to report cases of child abuse, reinforced by the prevailing belief that corporal punishment was permissible, contributed to this discrepancy. If Cultural and Societal Child Abuse were to be included, the actual incidence of child abuse in the United States would probably be as high as 10,000,000 to 15,000,000 cases per year.
This concludes the discussion on the incidence of child abuse in the United States. A review of the prevalence of child abuse in the United States follows.
PREVALENCE OF CHILD ABUSE
PREVALENCE OF CHILD ABUSE: Though individual cases of child abuse would elicit outrage from the American public, the basic belief in the efficacy of physical punishment and that children are the chattels of their parents has prevailed as a child-rearing practice. These basic beliefs, in turn, constantly reinforce the potential and actual child abuser. The parent who has been reinforced by society for punishing his child is more likely to abuse the child than the parent who has been reinforced for a competing behavior pattern. The major sustaining reinforcement of child abuse has been the persistent, earnest, and seemingly rational belief held by a substantial proportion of Americans that physical punishment is the best way to enculturate children.
Gil (1970) stated that studies suggested the primary cause of child battering was the culturally approved use of physical force in child rearing, which he felt was endemic in American society.
Since the cultural attitude permitting the use of physical force in child rearing seems to constitute the common core of all Physical Abuse of children in American society, systematic educational efforts aimed at (a) gradually changing this particular aspect of the prevailing child-rearing philosophy and (b) developing clear-cut cultural prohibitions and legal sanction against the use of physical force as a means for rearing children are likely to produce the strongest possible reduction in the incidence and prevalence of Physical Abuse of children. (p. 510)
Basic definitions of child abuse vary among specific individuals according to how they were raised and how their peer group disciplined their children. (Blumberg, 1978; Herjanic et al, 1978; Palmer, 1978; Wylie & Wylie, 1970). Military families that have been counseled, for example, did not recognize the possibility of child abuse until the child was severely battered or neglected. These families functioned in environments in which the use of strong punishment as a method of discipline was condoned, encouraged, and even rewarded. Maynard (1975) said:
In a case that I had a young enlisted man approached his commanding officer asking to be sent to psychiatric care because he was beating his two year old son. The commanding officer replied, as reported by the young man, "I don't want any psychiatric case in my command, besides discipline is good for the kid." This young man is here at the Medical Facility for beating his child to death.
In a nationwide poll taken by Harris and reported by Reynolds (1971), 84% of the American population sampled believed that the major problem with youth was that they were not disciplined enough.
Even government agencies have determined that the use of physical punishment as a method of enculturating children has not been successful. Rudd (1977) referred to a Department of HEW report, which supposedly stated that, spanking did not change behavior unless it was so traumatic that the child would have to be hospitalized.
Not only the belief that physical punishment is the best method of teaching a child prevails in the United States. The practice of isolating the child from warmth and affection as a disciplinary method also prevails. Steele (1976) recognized this problem and concluded:
Most abusive parents believe babies should not be given in to nor allowed to get away with anything; they should not be picked up and comforted when they cry, nor should they be permitted to become too dependent. These attitudes are common throughout the western cultures in a moderate form but they are expressed in rather extreme degree in abusive parent-child relationships. (p. 72)
The cultural and societal aspects of child abuse continue to be a focal point of contention. The empirical evidence clearly suggests that the use of corporal punishment and the withdrawal of affection as methods of enculturation have not been valid.
This concludes the discussion on prevalence of child abuse. A review of the description of child abuse follows.