Physical child abuse and neglect

I have been seeing so much about child abuse and neglect in the media lately. Why do you think this is happening so much these days? What can be done about it?

I will restrict my answer to physical abuse and neglect. This is not because sexual abuse is not important but because it is, in my opinion, a different problem for which we do not have a satisfactory answer other than gaoling the perpetrators.

At least 80% of parents who abuse their children were themselves abused as children. These parents have a very poor model of parenting and very poor self esteem. While they hated being abused and swore they would not do it when they grew up, under stress they revert to the model they experienced as children. They are, in fact, sad parents.

Of the remainder psychiatric disease, if one includes depression and alcohol and drug abuse under that heading, is the main reason. Very few abusers are simply evil people but unfortunately those that are capture most of the media attention.

At this point I should point out that if you were abused as a child it does not mean that you will become an abusive parent. 75% of abused children do not abuse as parents – a triumph of the human spirit! Also child abuse was not non-existent in the old days. It simply went unrecognised as a problem. It was not taught to me or any medical student in the nineteen fifties. There was a famous case of an abused girl who was brought to the attention of the courts at the end of the nineteenth century. The case was thrown out because a parent was totally responsible for their child. The case was brought again but under the Prevention of Cruelty to Animals act and was successful!

What can be done about it? The simply evil (bad) parents have to have their children removed and face the law. The psychiatric (mad) parents need psychiatric treatment and in many cases the children may need alternative care at least on a temporary basis.

However, the vast majority (80%) need support in their parenting and many organisations attempt to do this. In the old days family and neighbours did this but this often not available in modern society. Unfortunately, the main need is for emotional support – not budgeting, housekeeping etc (although this may also be needed)-and this takes time: more time than society can afford to pay if one uses an employed social worker, visiting nurse or any paid supporter. The most successful program was introduced by the late Henry Kempe in which he used trained volunteer mothers whose task was to “mother the mothers”. This program has been emulated in many other places around the world. I ran one such program with the high success that Kempe found but it took 20 hours per parent per month. Society simply could not afford to pay a salary for such parent-helpers given the rates of child abuse that we currently have.

In the last 50 years we have recognised the problem of physical abuse and neglect. We have learnt a lot about its causes and I think we have found a successful treatment for many cases. It is a dismal picture at the moment but I believe there is cause for hope.