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10 Controversial Medical Questions Answered by Dr. Dalrymple

Where do you stand on these challenging ethical and scientific debates?

Theodore Dalrymple


March 15, 2014 - 8:00 am
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From September 2013:

9. Are obese children victims of child abuse?

Nothing illustrates better than child abuse the tendency of ill-defined but nevertheless meaningful concepts to spread beyond their original signification to include more and more phenomena.

Recently I was asked by BBC radio to discuss (in three minutes flat) the question of whether morbidly obese children were the victims of abuse by their parents. By coincidence, the Lancet of that week published an editorial on the psychological abuse of children and what doctors could or should do about it.

Nothing illustrates better than child abuse the tendency of ill-defined but nevertheless meaningful concepts to spread beyond their original signification to include more and more phenomena. The evolutionist Richard Dawkins has even suggested that to bring up children in any particular religious faith is a form of child abuse, since the child’s subsequent freedom to choose his beliefs according to the evidence is thereby impaired: in which case the history of all previously existing societies is not that of class struggles, as the Communist Manifesto has it, but of child abuse.

The editorial in the Lancet referred to a report on the psychological maltreatment of children by the American Academy of Pediatrics, the general drift of which was that such maltreatment is protean in nature and has bad effects upon children later in life, from mental illness and criminality to inability to form close relationships and low self-esteem. Maltreatment is dimensional rather than categorical: at what point does “detachment and uninvolvement” give way to “undermining psychological autonomy”?

Likewise “restricting social interactions in the community” can be a form of maltreatment, but so can failure to do so, in so far as association with undesirables might “encourage antisocial or developmentally inappropriate behavior.” Parenthood is thus a constant navigation between various Scyllas and Charybdises, and is rarely entirely successful. Surveys show that about one in sixteen people in Britain and America consider themselves to have been the subject of psychological abuse in childhood. I count myself as among the abused.

The report considers what can be done to reduce the psychological abuse of children, both on a population and an individual level. It is rather coy about what kind of families are most likely to maltreat their children psychologically, perhaps because this would produce yet one more stick with which to beat the poor; and as for the “treatment” of individuals, the report supposes that most psychological maltreatment is the result of error or misunderstanding rather than of malice and depravity. Thus, it can be righted by a little training and exhortation. Doctors are uncomfortable when confronted by the intractability of human malice, and perhaps it is as well that they should be.

I read something in the report that took me back to my student days:

Severe forms of psychological deprivation can be associated with psychosocial short stature, a condition of short stature or growth failure formerly known as psychosocial dwarfism.

Back in the early ’70s, we were taught that the failure of abused children to grow normally through what was then called “maternal neglect” was caused by an insufficiency of food. A horrific experiment had been performed in which maternally deprived children were taken from their mothers and divided into three groups: those given food and affection, those given food but no affection, and those given affection but not enough food. The children in the first two groups grew in an accelerated fashion and by the same amount, those in the third did not. The horrible conclusion was that affection was not necessary to growth.

I am very glad if this is not so. I note, however, the report’s weasel words “associated with” rather than the unequivocal “caused by.” And speaking for myself – and only for myself – I think the psychological maltreatment that I suffered as a child did me some good as well as harm. It put a certain iron in the soul as well as gave me certain defects of character.

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All Comments   (9)
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More than half of these questions would simply go away if everyone (or their family or close friends as needed) paid for their own health care. For the remainder - perhaps excerpting parental responsibility for an obese child - it is sufficient for everyone to have their own opinion and act accordingly.
40 weeks ago
40 weeks ago Link To Comment
There's so much PC BS on most topics that it's startling to hear or read TS, "true speak." Thanks, Doc.
40 weeks ago
40 weeks ago Link To Comment
RE: Obesity & RE:Healthy Diet. I know 17 people with Hypo-Throidism, & most continue to gain weight eating healthy low cal diets with lots of aerobic exercise. I doubt most overweight people have this, but some do have a medical reason for obesity, likely a small minority. Those who simply choose a poor diet likely fall into one of these categories...1) I will eat what I want (needs immediate & constant gratification). 2) Too uninformed (or ill informed) to make intelligent choices. 3) Too poor to buy healthy food (the price, per calorie, of junk food has dropped, while the cost of real food has skyrocketed). If most people would eliminate all processed foods made with white flour & white sugar, & replace that with a MUCH SMALLER amount of whole grains than the food pyramid recommends & eat mostly lean sources of protein + lots of organic produce, they would naturally loose weight. For weight loss to be permanent, you have to make permanent changes!! "Let thy food be medicine & let thy medicine be food"...Hippocrates
40 weeks ago
40 weeks ago Link To Comment
Here in NV our absurd Medical Marijuana laws require a patient to break the law BEFORE they can comply with it. First, you have to break the law & illegally obtain the seeds. Then you apply for a Medical Marijuana card ($50.00), then pay another $50.00 for an "Illegal Contraband Tax Stamp", (no I'm NOT making that up). Then you have to "grow your own". Once "your crop comes in" FINALLY have your medicine. As a patient who laid in bed CRYING AND SCREAMING IN AGONIZING PAIN FOR MONTHS ON END, because pain pills don't work on me, NOT opiates & NOT NSAIDS, I can tell you that "witch hunt" leveled against Medical Marijuana is merely "cover" to TORTURE cancer patients like me. I choose not to break the law, because there's no telling when/who the Fed. Gov't. will turn on next & my Hubby is a legal immigrant, here on a Green Card from I SUFFERED!! The freely available (by RX) dangerous, highly addictive, toxic narcotics & their horrific side-effects they "experimented on me with" are what we should be worried about...NOT a plant that grows out of the ground!!
40 weeks ago
40 weeks ago Link To Comment
With the understanding that people should be free to obtain help for obesity, addiction, and all health issues at any age, but cannot demand that others pay for this treatment (Charity given by others is ok and encouraged), my take is as follows. Let the debate begin.

1. Obesity is neither a disease nor a moral failing
2. Alcoholics should not be denied available medical care
3. Psychiatric illnesses merit treatment as much as physical illnesses
4. Doctors sometimes are guilty of giving pain killers to addicts who con them
5. Elderly should not be denied available medical care
6. Marijuana can be a medicine, with side effects
7. Nutrition is important to health
8. Drug addiction is not like non-addiction illnesses but addicts should be treated
9. Obese children are not victims of child abuse
10. Parents should vaccinate their children
40 weeks ago
40 weeks ago Link To Comment
Interesting that the author chose only one vaccine to discuss pros and cons.
40 weeks ago
40 weeks ago Link To Comment
He must be in on the CONSPIRACY!!!!!!!
40 weeks ago
40 weeks ago Link To Comment
A government funded psychiatrist on an NHS pension in on 'the conspiracy'? No. Not possible.
39 weeks ago
39 weeks ago Link To Comment
Thank you, Doctor, for this thoughtful and objective article. These are two qualities that in tandem are virtuous but rarely encountered today.
40 weeks ago
40 weeks ago Link To Comment
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