They only hit you 'til you cry

After that you don't ask why

You just don't argue anymore -- Lyrics from "Luka," by Suzanne Vega

The song is a big hit these days. It speaks to the dark terror of a family run amok; of a wife being battered by her mate; of a child abused by a parent or an aunt or uncle or cousin or grandparent. It speaks to the psychological deadlock between the abuser and abused so that no matter how severe the violence or how long it has taken place, the victims "just don't argue anymore."

The statistics are familiar. According to the National Coalition Against Domestic Violence, every 18 seconds a woman is beaten somewhere in the United States. More than a million -- some estimates say up to 6 million -- wives are "battered" every year. There's a rape every minute, frequently by an acquaintance of the victim. An estimated 3 percent of the older population is abused physically or psychologically, usually by a spouse or adult child.

And now, researchers are recognizing a pattern in domestic violence. The linchpin, it appears, the hidden generator of much of this trauma in the American family, is child abuse, especially child sexual abuse. Many experts believe child abuse may be at the root of a significant proportion of street violence as well.

The old homily, that home is where the heart is, doesn't tell the whole story anymore. Home is also where the heart is broken.

"The price we pay for this kind of child abuse is that it generates a whole group of people who go out and transmit this violence into our society in the form of rape and sexual violence and aggression," says Dr. Frank Putnam, a psychiatrist at the National Institute of Mental Health specializing in the long-lasting effects of child abuse. "If we could do something about child abuse, we would have all sorts of ripple effects that would benefit everybody."

The trouble is that child abuse has been an unseen shadow lurking in the corners of schools and homes, for countless years. The abused child grows up to be the abusing adult, and the cycle continues.

What's more, the latest figures on the growth of domestic violence in the Amer- ican family are discouraging.

The Select Committee on Children, Youth and Families, headed by Rep. George Miller (D-Calif.), found that between 1981 and 1985, the number of children reported to have been abused or neglected rose by 54.9 percent, with reports of sexual abuse rising the fastest -- 57.4 percent between 1983 and 1985 alone. It is estimated by the committee that almost 2 million children a year are abused in some way.

"Americans," says Dr. Stefan Pasternack, a Washington psychoanalyst who treats victims of abuse, "sometimes don't seem to care very much about their children." They build big expensive schools, pay fortunes in babysitting costs, buy all sorts of gifts, but "there is a very large segment of the population, a frighteningly high number of people, who neglect and abuse." The Abused Child

Andrew Henry Vachss, pulp novelist with a mission and a lawyer who represents children in abuse cases, is among the people who believe child abuse is at the heart of violence in our society. He tells the story of one child he represented -- an 8-year-old boy -- to demonstrate how early such patterns can become imprinted.

"He would shock most hardened cops," Vachss says. In this case, a mother was walking through a shopping mall with her 3-year-old who suddenly wanted to go to the bathroom. "He's too big for the ladies' room, and she doesn't want to let him go into the men's room alone," Vachss says.

"The 8-year-old suddenly appears and offers to take him in. The mother happily agrees. Then, when he doesn't come out and doesn't come out, the mother gets a guard or a policeman to go in. And they find the 3-year-old in the sailor suit beaten and sexually assaulted. The 8-year-old is gone."

The older boy in this case had been a victim of sexual abuse himself. "He was taught to do that," Vachss says.

Can such a child be rehabilitated? "I don't think so," says Vachss. "If a shark started with your toes, he'd have far to go before something couldn't be saved. But if he started with your head?"

The response of that 8-year-old to his own earlier brutal use as a child prostitute illustrates what can happen to a psyche that is profoundly damaged through sexual abuse. Vachss, whose novels dramatize the results of abuse, contends that without therapy, such children are likely to either "act 'out' " their aggression or "act 'in.' "

"If they act 'out,' they commit violence," he says. "If they act 'in,' they commit suicide." Vachss, of course, is describing children of abuse in the most extreme circumstances, but the results of sexual assault in childhood in less brutal environments appear to differ only in degree.

An expanding body of medical research is documenting other effects of child abuse, and how they are translated into behaviorial abnormalities later in life.

Psychiatrist Putnam of the National Institute of Mental Health and his colleague Dr. Penelope K. Trickett, a developmental psychologist, are starting one of the first long-term studies of abused children ever attempted. Operating on the basis of some new findings, Putnam and Trickett will follow several groups of sexually abused girls from the time the abuse is discovered through puberty.

Already, preliminary findings of these studies indicate that:Child abuse may be a key cause of later psychiatric illness. Abuse can lead to abnormal sexual development, possibly actual hormonal changes. In its worst manifestation, it also can also lead to what has been called multiple personalities.

The psychiatric work is showing that 15 to 20 percent of psychiatric patients were abused as children. "Those are big-time numbers," Putnam says.

Surveys also show that women who were sexually abused as children frequently become highly sexualized. Some run away from abusing homes as teen-agers and become prostitutes. In any case, they are very likely to become sexually promiscuous.

The studies of unusual physical development are even more compelling. Histories of sexual abuse, he says, are found in virtually all young girls who mature sexually at a much younger age than normal -- at 9 or 10, for example.

Putnam says that one NIMH psychiatrist who consults on such cases has stopped asking parents, "Was this child abused?" Instead, he now asks: "When was this child abused?"

Scientists know that environment can exert a powerful influence on the endocrine system. Animal research as well as studies of athletes show that hormones can be altered by external conditions. Female marathon runners, for example, may stop menstruating during long courses of training.

Putnam and Trickett expect to document a comparable effect in the 100 abused girls they will study, demonstrating that they "are really being developmentally altered hormonally."

"Typically," says Putnam, "the sexually abused child gets much worse during puberty. It is when they hit adolescence that they become symptomatic -- you get runaways and promiscuity and aggression and a lot of physical complaints."

In addition, Putnam wants to test these abused children for what are called "dissociative states." Best known for his work on what has been called "multiple personality disorder," Putnam now believes that the condition comes from a traumatic interruption of the child's normal development -- the integration of budding states of being into a single "self."

As a defense mechanism against confronting what seems to be an unbearably cruel world, the severely abused child may never form that "self," and instead remain a loose collection of various states.

"People are always amazed at how a little baby can be crying its eyes out one minute and smiling and going goo goo the next," Putnam says. "As we grow, we sort of smooth out those transitions, and we have a more continuous sense of ourselves and how we feel across different states of consciousness.

"What happens with the multiples is that it becomes advantageous to keep the states separate."

It is now widely accepted that severe, prolonged sexual, physical and psychological abuse almost always lies at the base of these multiples.

But ending up with multiple personalities is only the extreme reaction in cases of extreme cruelty. In the majority of cases, people whose development is traumatized in childhood are left with low self-esteem, inability to form intimate relationships and a host of insecurities and uncertainties and, of course, they bring these scars into adult life.

Film star Marilyn Monroe, whose sexuality on the screen made her famous, was a classic victim of childhood sexual abuse. Her widely publicized insecurities, failed relationships and suicide in August of 1962, constitute a textbook case of early abuse turned to self-destruction.

Men and Women

All of this is reinforced by a society that often looks the other way when a man strikes a woman.

In a recent national survey of young men in college, 25 percent said they had committed -- or tried to commit -- a sexually violent act against a female companion. "To them," Surgeon General C. Everett Koop said told a group of juvenile court judges recently, "their behavior was merely part of the 'game' of male-female relations.

"Men and women do not generally interact as equals, and men in particular tend not to treat women equitably."

That such abuse continues to be so widespread, authorities such as Koop believe, results from the nation's look-the-other-way mentality, starting with child abuse and continuing into the abuse of women.

The response of local police still tends to reinforce this attitude, although recently formed "domestic violence" squads are demonstrating a newborn sensitivity to such problems in scattered areas.

Last year in Montgomery County, for example, there were more than 8,300 calls to the police involving "family trouble," and in 7,800 of those instances there were no arrests.

"The police came and sort of said, 'behave yourself,' " says Neal J. Meiselman, an attorney specializing in family law.

There were 540 cases in which a criminal report was filed, including 98 cases of "aggravated assault," which meant use of a gun, cutting or stabbing or even an attack with a car.

"Montgomery County," says Linda Haspel, former chief attorney at the county's legal aid office, "is not that different from the rest of the country."

Nationally, one in six calls results in an arrest. In most cases, the couple is advised to "try to work it out."

Arrests in these cases are not high on the

law enforcement priority list, says Meiselman. One reason for this is that spouse abuse often follows a cyclical pattern. Accordingly, tensions build to the episode in which police are called, followed by a period of remorse and tenderness on the part of the batterer and, more often than not, a decision to give it another try. "So by the time one of these cases would get to court, the couple would be in that honeymoon phase," says Meiselman.

Still, notes Meiselman, "studies show that the single biggest deterrent to wife beating is an arrest. So the police are actually failing to use the single most important weapon against abusers -- arrest."

In one study, Meiselman said, an estimated 41 percent of the married women assaulted by their husbands who did not call the police were subsequently assaulted by him within an average of six months. Among the women who did call the police and the man was arrested, only 15 percent were re-assaulted.

Because the criminal justice route is often difficult for abused spouses to pursue, Haspel and Meiselman are promoting an intermediate step short of criminal or divorce proceedings -- a civil remedy in which an abused spouse can petition a judge to keep the spouse away for a period of time. This action also helps the abused person find appropriate help and support.

A newly expanded Maryland law provides for this route, but because it is little known, Haspel and Meiselman hold periodic seminars for those who may be abused themselves or have a friend or relative who is.

In his speech last month to the annual conference of the National Council of Juvenile and Family Court Judges, Koop recalled his days as a practicing pediatric surgeon.

"I had many moments," he said, "when I simply did not believe that the child whom I was examining had really met with an 'accident.' And I am haunted by the children who ought to have won my attention and my protection at the time. But perhaps I let them down.

"And I've often asked myself why. The answer that makes the most sense is that, when I looked at the parent and tried to see him or her as the guilty party, I saw another adult -- someone like me, someone who obviously 'knows better,' and I dismissed the evidence of my own hands and eyes.

"I think," said Koop, "there is a kind of conspiracy of adults against children. And we ought to be ashamed of ourselves."

And yet taking legal action against abusers is difficult. Children are easily intimidated by other adults, and sometimes court cases require them to recount horror-filled and harrowing experiences over and over. A parental concern and anguish for a child may give the child the erroneous impression that the parent disapproves, that the child was somehow "bad." And Linda Haspel and Neal Meiselman note that some of their cases involve unfounded charges of child abuse made by angry partners in custody disputes. The answers are hard, and hard to come by. But now at least somebody is beginning to ask the questions.

Taking Action

One step, Koop and others believe, is for physicians to play a more active role in identifying abuse and getting help for the victims. "Obstetricians who ignore the physical signs of battering among any of their pregnant patients are practicing bad medicine," Koop told the juvenile court judges. "And judges who trivialize family violence -- especially the crimes of woman battering and sexual assault -- are practicing bad law."

To heighten awarness,, the surgeon general is preparing a letter to be sent to health care professionals teaching them "what to look for" when dealing with child sexual abuse.

It will urge the professionals not to ignore "gut feelings" in cases where a child's story about a fall from some playground equipment does not adequately explain pain in the genital area, or why a child appears sullen or especially fearful about genital examination. It will detail explicit signs of sexual abuse and ways to examine the child without terrorizing him or her all over again.

And it will explicitly detail how the legal system can be brought in to help the victim discovered by the health care system.

Said Koop: "We hope {the letter} will contribute to better service for child victims and their families and to more convictions that stick among the perpetrators of this heinous type of crime -- and that it will also help protect innocent people who are falsely accused."