10 Controversial Medical Questions Answered by Dr. Dalrymple
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.