The Battered-Child Syndrome
Name it to tame it.
When we think of vileness, we think of child abuse. When asked what abstract “evil” might look like, we describe child abuse— someone small and blameless who deserves no harm, being hurt— and by hands that reared them no less. It was only recently that child abuse began to be understood as a pervasive problem, “not as a sensational exception but a common syndrome.”
[ Trigger warning: this post is about child abuse. Find a comfortable, peaceful place to read if you chose to continue. ]
The recognition and identification of child abuse started in the medical arena. Across many years, doctors and nurses saw young patients whose injuries startled them. Infants and children presented with confusing bruising, fractures, soft tissue swelling and subdural hematoma (blood between the brain and skull), amongst other symptoms. Yet these injuries were inconsistent with the child’s level of development and the caregiver(s)’ explanation of incursion.
Those of us who’ve experienced abuse know abusers would have a ready narrative to allay suspicion. Many people struggle to identify lying (a future post). How dangerous it is to be gullible when the tale-teller is an abuser. Health professionals fell for the abuser’s story, delaying correct identification of the problem, permitting further harm.
As health professionals encountered more cases, false narratives came under greater scrutiny. Eventually, Dr. C. Henry Kempe and other medical researchers examined this problem. They gave it a name by publishing their research paper “The Battered-Child Syndrome” on July 7, 1962 in the Journal of the American Medical Association.
Prior, health practitioners thought they encountered a startling, disparate collection of accidents. Now, symptoms were understood as an interconnected constellation pointing to intentional harm. These were not the naturally occurring bumps and bruises of childhood development, as previously (even willfully) believed— but intentional trauma; a clinical condition meted out by “caregivers” (a misnomer). Later assessment of the paper’s impact commented that its greatest contribution was not the identification of abuse indicators, but that it raised awareness of the extent of child maltreatment. (Meton 2005)
The second author of the paper, Frederic Silverman, a radiologist, worked with what was then a cutting-edge technology. He commented, “The bones tell a story the child is too young or too frightened to tell.” Child abuse (in all its forms) has likely always existed, although historical records are lacking. The absence of medical or legal frameworks stymied efforts to identify and analyze, prevent and prosecute child abuse. The publication of “The Battered-Child Syndrome,” presented a new paradigm to address what had been obfuscated. It let the bones talk.
Confronting evil is tiring; we feel fatigued at the confounding, wearying nature of its existence. It is why most people prefer to turn a blind eye to difficult things. In researching my master’s thesis, which covered the protective parent experience, many interviewees suggested child abuse persists because “no one wants to poke the bear.” This same phrase came up again and again. People want to run away from the bear. It’s ugly, dangerous and frightening.
When encountering suspicion or evidence of abuse, with palms flared, we think “how could you?” We struggle to understand how someone puts hands on a kid. (how about a future post on the internal logic of abusers? comment if you’d be interested) When meeting with some dark contortion, though, it rarely helps to get aghast. We should let go of feeling disturbed, apply our analytical mind and move on to problem solving. It took health practitioners repeated exposure to a shocking problem to get down to analysis.
In the dark, depressing field of child abuse, it’s encouraging to know there have been some advancements. Kempe and others put in time, energy and expertise to call a thing out by what it was/is. They gave it a name to bring it into the light and try to address it. Imagine how health practitioners would have had to reckon with how mistaken and ignorant they’d been. Abuse survivors can relate, right? We kick ourselves to look back and see what we didn’t see clearly.
The recognition of battered-child syndrome pointed to further blind spots. The paper abstract noted, “Psychiatric factors are probably of prime importance in the pathogenesis of the disorder, but knowledge of these factors is limited.” The National Library of Medicine defines pathogenesis as “the mechanisms by which [a condition, disease or illness] develops, progresses, and either persists or is resolved.”
Associated words include “pathology” — the study and diagnosis of disease, and “genesis” — the origin or coming into being of something. Understanding of pathogenesis of a condition “is critical for discovering, developing, and implementing methods to prevent [it.]” (NLM) Without knowing the origin of a problem, we are hard-pressed to prevent or resolve it.
In suggesting that “psychiatric factors” were likely related to battered-child syndrome, authors ostensibly expected the caregiver to have some mental, emotional or behavioral disorder. They noted, however, that the "beating of children is not confined to people with a psychopathic personality."
Kempe et al also wrote they expected doctors would "have great reluctance in believing that parents were guilty of abuse." Such reticence continues today. As evidenced, anecdotally, in conversations I had with people directly impacted by child abuse— their assessment that “no one wants to poke the bear.”
In his time, Kempe (and others) raised awareness of child maltreatment. Let’s keep the stone rolling— keep talking about child abuse, let others know how it’s still around, and how people try to hide it. Share your story with others and forward this post.
Take care.