A teen-age mother, frustrated and feeling trapped at home with her 3-year-old daughter, routinely screams at the child, "I wish you were never born." A 5-month-old boy is left unattended in his crib day after day until the back of his head is worn bald. A Maryland father holds a pistol to his 8-year-old son's face to teach him a lesson he'll never forget.
There are none of the bruises, blood and broken bones sometimes found in child abuse cases involving beatings and sexual molestation that scream so often these days from newspaper headlines. Rarely does child abuse that scars only the mind make the news. The most severe cases occasionally attract attention of the authorities. But the vast majority go quietly unnoticed -- except by the victim.
Despite growing recognition by mental health and legal experts that "psychological maltreatment" of children, as it has now been labeled, is an insidious and largely invisible assault on the minds of the nation's next generation, the problem proves difficult to identify, even harder to define. When the target of abuse is gray matter alone, issues and answers get stuck in a murky gray area of controversy.
"We don't have any consensus. We can't agree. That's the heart of this problem," says Dr. James Egan of the intensifying debate among experts on what constitutes psychological abuse and how to remedy it. As head of psychiatry at Children's Hospital in northwest Washington, Egan says virtually all of the psychologically abused children he identifies come to him for other complaints. It's a fact, he says, that indicates the intangible nature of the evidence of mental harm.
"If you take a child that has had a cigarette burn put on by a parent ... the major reason that is damaging is not the damage to the skin," says Egan, who argues that psychological abuse is the "dominant part" in most physical abuse cases. "To break an arm skiing is not generally considered damaging to a child. The same broken arm caused by a parent is considered an unthinkable condition. The difference between those two broken arms has to do with the psychological meaning of the experience."
Egan says the array of abusive conditions he sees every day is enough to boggle the mind. They regularly exceed manageable and practical definition of a problem he thinks threatens family life and social stability in the United States. Recently, a woman who brought her 13-month-old child to Children's Hospital admitted to doctors that her family name and her child's name were different because the child wasn't really hers. "She said she only liked little babies, and her sister liked older children," recalls an angered Egan. "So she gave her sister her own 30-month-old in exchange for her sister's 13-month-old.
"Why isn't that neglect and abandonment? It's child abuse in my judgment. The child has been abandoned at will by the parent, and not because the parent was ill or infirm or incarcerated or any of the other situations. Those children's experience was that the parents didn't want them. That makes it very damaging."
But is it illegal? "No," he answers.
Another incident Egan recently witnessed may, indeed, have been illegal -- but not because of its psychological injury to the children. While driving on I-270, he spotted a blue Chevette traveling at about 60 miles an hour with its hatchback open. Playing on the platform near the open hatch were two small children. Most would recognize the senseless physical danger the children were subjected to, says Egan. But the implicit message to the children calls into question their value to their parents. Again, to Egan, that constitutes psychological maltreatment.
"These kinds of things would strike me as being unthinkable if I didn't see it literally every day," he says, "if I didn't see it in supermarkets, on the street corners ... In the last 20 years, we've seen the psychological maltreatment of children increase. We've also seen more suicides, more eating disorders, more academic problems, a higher percentage of out-of-wedlock pregnancies among children. The children are showing the signs of serious disorder."
But Douglas J. Besharov, resident scholar at the American Enterprise Institute who served as the first director of the then Department of Health, Education and Welfare's National Center on Child Abuse and Neglect, argues that such cases go beyond an operational definition of mental abuse to children. To include them, and other incidents like them, is to blur society's focus on the more urgent and serious cases that injure children.
"If you define it broadly enough, it is everywhere," says Besharov, who resists what he calls a movement among some mental health professionals to see it that way. "Most of the impetus for this broadening definition comes from a well-meaning, good-faith desire to protect children ... but there are big sufferings and little sufferings.
"The trouble is that there isn't great agreement on what emotional abuse is," says Besharov. "There are clear cases of emotional abuse and neglect. Anybody who says there is no such thing is engaging in the same kind of extremist hyperbole as those who say it is all around us and we've got to take action now."
Most experts, including Besharov, do agree that an increasing number of serious abuse incidents fall through the crack between ambiguous definition and the lack of a clear-cut solution. But how many is debatable. Since Congress almost inadvertently included "mental injury" (with no further clarification) in the Child Abuse Prevention and Treatment Act of 1974, states have been required to report cases of emotional abuse and neglect. But using what amounts to a "know-it-when-you-see-it" approach means the tally of actual cases remains as fuzzy as the definition. Counting state and research figures, an article in the February issue of American Psychologist estimated "conservatively" that about 200,000 incidents of strictly emotional abuse take place in the United States every year. Some experts scoff that that is the tip of the iceberg, pointing out that it is probably inherent in what some estimate to be a million-plus cases of physical abuse and neglect of children each year.
"The truth of the matter," says Besharov, who is an attorney, "is that fewer than 2,000 children die of abuse and neglect every year. That makes it the fifth most common cause of death among children under 14, and obviously a cause for national concern. It doesn't make it a case for national crisis or for a no-holds-barred emergency response."
But for the problem to gain public and media attention, contends Besharov, cynics would require a million incidents a year. "The way to build up the incidents to a million," he says, "is to include all forms of child neglect and all forms of emotional abuse, including shouting and belittling children. Only when you include all forms of emotional abuse do you get anywhere near a million.
"Serious psychological abuse cases amount to 200,000 a year," he says. "That is a serious enough problem and we ought to do something about it. We just don't have to exaggerate it."
Stuart Hart, a professor of educational psychology and director of the national Office for the Study of the Psychological Rights of the Child at Indiana University-Purdue University at Indianapolis, is halfway through a two-year project sponsored by the U.S. Department of Health and Human Services to develop an operational definition of emotional maltreatment. He sees the emotional abuse of children as "a powerful challenge to our culture" that demands a comprehensive remedy and not a "fragmented, crisis-only, quick fix."
Working with psychologist Marla Brassard of the University of Massachusetts at Amherst, Hart is attempting to draw the line that separates what is and isn't emotional abuse. "If you consider treatment of children as a continuum with highly positive and supportive interaction on one end and severely damaging acts on the other," explains Hart, "we're looking at things that fall from the extremely negative point to some neutral point -- in other words, the mildly to moderately to severely destructive."
Extreme acts of emotional abuse and neglect are easily identified -- by experts and by the courts. For punishment, a child is locked in a dark closet for hours, or even overnight. A child is tied to a bedpost while the parent goes to the store or to work. Failure to thrive -- children who aren't emotionally nurtured enough start losing weight and can even die -- is considered emotional neglect. Hart adds to this list acts of continual humiliation (hanging the sheets of an adolescent bed-wetter from his window), isolation from outsiders and peers, constant degrading and terrorizing.
But, in its milder forms, what appears to be psychological maltreatment to some experts is considered by others simply poor parenting. Among actions that Hart includes as emotional abuse are setting low expectations for a child, failing to give a child attention, putting unfair pressure on a child, using coercive discipline and punishment, even milder forms of put-down and rejection ("He's the clumsy one in our family" or "She's the slow one").
Sometimes what parents brush off as just talk, some mental health experts believe is abusive and damaging language: "The parent that says, 'Why don't you go live with your father,' or 'I'd go crazy if I had to stay home and take care of you,' " says Egan. "That's just routine talk in many homes ... Most parents, even when they do things that we would consider damaging, have the notion that they are doing something useful for their child."
But where Dr. Egan contends that a parent who fails to use a seat belt for a child is harming the child mentally, Besharov argues for a distinction: "It is very dangerous behavior. But we don't use the family court system to deal with that. We fine people. We give them tickets. These people don't need a social worker once a week. They need to be told, 'Don't do that anymore.'
"What happens," adds Besharov, "is some use the extreme stuff to justify government intervention in other cases where the problem isn't so obvious, where the amount of harm to the child isn't that great, what we could call 'inappropriate child-rearing.' Constant belittling of a child, shouting at a child ... We know it is not good for them. But we don't know how bad it is.
"We know you shouldn't park a child in front of a television for 12 hours. But it isn't child abuse. It's bad child-rearing ... Sadly, there has been this tendency recently to call this kind of thing psychological abuse. My answer is that's a little like going out to fill potholes when you've got gaping holes in the bridges."
Besharov says the best definition of emotional abuse is the simplest and most direct: "It has to be severe and have a demonstrable effect on the child's mental condition. Severe in that it has to be a big deal. And demonstrable in the sense that you can point to something and be able to say, 'See, that child is 12 years old and still not talking.' This is not a perfect answer. But it divides the wheat from the chaff."
Yet Egan wonders how society can use a standard that requires evidence that probably won't show up for years. And he rebuts the argument that suggests if no mental damage is caused in some cases by certain acts, the acts shouldn't be defined as abuse. "We do better protecting the snail darter and monkeys in experiments than we do protecting our kids ... The legal ambiguity is that we can allow parents to do almost anything to their children. That frustrates me. Having said that, the system of having the government take over the problem has been a disaster, too. All we have left is the forging of a societal consensus that these actions are bad."
Stuart Hart, who believes psychological maltreatment is a major cause of crime and antisocial behavior, proposes a comprehensive approach to the problem -- both preventive and remedial. "We want to encourage good parenting practices," says Hart, "but those conditions and acts which are clearly excessive, that are out of the gray area, particularly when combined with symptoms of emotional maladjustment, need to be stopped.
"To a certain degree ... we have all done and experienced a little bit of this -- some more than others -- but usually not so intense, or so frequent that it has been destructive. But the ones who are the most destructive are not ... so completely different from us."
For further information on child abuse and psychological maltreatment, contact the National Committee for the Prevention of Child Abuse, 332 S. Michigan Ave., Suite 950, Chicago, Ill. 60604. For single copies of Stuart Hart and Marla Brassard's booklet, "Emotional Abuse: Words Can Hurt," enclose $2 plus 50 cents postage.