Re: Crisis of legitimacy (child abuse)

Michael Cahill (MCBlueline@AOL.COM)
Mon, 6 May 1996 15:04:05 -0400

John McCreery has asked about the project I'm currently working on. For
various reasons, most of them probably bogus, I've been reluctant to really
get into it before, although I keep yapping around the edges of it. The
project is essentially an ethnographic study of child abuse in lower
working-class America. Hence my interest lately, in this list, in all forms
of "abuse" or victimization. "Concern number one" is that child abuse is
still politically a very sensitive issue, even though it's been studied
seemingly to the nth degree by virtually every social science discipline.
(For a feel for just how sensitive the whole issue of family violence
remains, see Richard Gelles' and Donna Loseke's book, _Current Controversies
on Family Violence_ 1993.)

Concern number two: while anthropology has examined child abuse in other
cultures (see, for example, Jill Korbin's _Child abuse and neglect:
Cross-cultural perspectives_ 1981), what I'm doing constitutes one of the
first fuller length attempts, that I know of, to apply anthropological
methods to child abuse *in America.* Now, you might think there'd be no
problem here, but it has occured to me that what an anthropologist might have
to say about American child abuse (and American child protection) might not
be really appreciated -- either by anthropology or by the policy sciences.
Why? Well, because -- on the policy-making side -- to set American social
problems and American institutions of social control in wider cultural and
historical perspective is to make them both appear a little *strange.* And
one can see how policy-makers might find strangeness unsettling and
"difficult to use." (There are a couple of interesting "strange-ifying"
essays in Nancy Scheper-Hughes' book entitled _Child Survival_ 1987,
including a view from inside the child welfare system by D. Michael Hughes.)
On the anthropology side, the objections would be the traditional ones: "why
don't you stay in your own yard" (i.e., the rest of the world), and
"anthropology already looks strange enough to the policy sciences, do you
have to add to the problem?"

In other words -- I'm just plain chicken. Moreover, a lot of what I might
say is probably wrong. For some reason, I'm having a hard time buying the
notion that knowledge proceeds from error to error. This is true, but hard
(for me) to accept.

So, what's my thesis? Well, remember, since the work is ethnographic, I'm
more interested in describing things than I am in proving a hypothesis. But
there some likely suspects when it comes to "conclusions" of the study. The
first one is that, seen in world historical perspective, "American"
(especially American *legal*) definitions of child abuse and neglect are
somewhat arbitrary. This is hardly surprising. But, if you're a
policy-maker, for example, what do you do with the following
"anthropological" facts:

a) Americans abhor "other cultural" scarification or mutiliation of children,
but think nothing of piercing their own kids' ears (and now, I'm told,
septums and belly buttons) and bracing their teeth (a very painful practice,
I'm understand). Moreover, while Americans decry the bodily injury to which
children in other cultures are often exposed, they think it an important
character builder to involve their own kids in organized sports where
numerous injuries occur -- some of which are serious and even fatal. The
point I'm trying to make here is not that we should outlaw contact sports for
children or ban body piercing or braces, but rather that while children
experience pain or come to harm everywhere, for one reason or another, only
some of these pains or harms, and not others, get called "child abuse and
neglect" in a given culture. It's not easy to "objectively" measure these
things. The perception of injury or harm is *relative* to a whole universe
of questions (most of them implicit), including "what kind of a person do I
want my child to grow up to be?"; what kinds of qualities do I want him or
her to develop?"; "What kinds of people and activities does my culture
value?" The bottom line is, will these insights help policy makers make
definitions (and labels) less arbitrary? Actually, from a policy
perspective, some of them are probably better side-stepped.

b) Americans condemn incest and intrafamilial sex with children (child sexual
abuse), yet they appear to sexualize children in other spheres all the time.
Advertizing is notorious in this regard, using sex to sell clothing, makeup,
food, and many other items to children. What is a policy-maker going to do
with this insight, try to "perp" and investigate Calvin Klein for child
abuse? (The firm _has_ been criticized in the press recently.) This brings
up the whole question of the proximate and ultimate causes. American
anti-child abuse policy is firmly focused on the proximate causes of child
abuse and neglect ("persons legally responsible," usually parents and certain
kinds of caretakers). The role of ultimate causes, whether social or
cultural, is underappreciated, understudied, and likely to remain that way
from a social control policy perspective for political (actually cultural)

A second conclusion derives from the foregoing. Because of the fuzziness
associated both with definitions and with the role of proximate-ultimate
causes, child abuse and neglect are often confused with povery, sociocultural
differences in child rearing, and accidents. In practice, the shortcomings
in the "tests" used to screen for child abuse mean that the system ends up
taking in a lot of "junk" -- including problems that should be handled in
other ways by other agencies -- and yet it often misses much of what it
should be capturing (emotional abuse, for example). In the bargain, agencies
spread themselves too thin and run the risk of mishandling cases.

To use a medical analogy, the current praxis of most protective systems might
be likened to premodern surgery. Agencies enter the body of the family with
a dull instrument -- the child abuse report -- in response to virtually any
symptom without the social equivalent of anaesthetics or antibiotics. In
many cases, little is discovered or healed; in others, some tissue is
misidentified and disturbed. After closure, a relative few families are
closely monitored and somewhat over half of them report feeling better though
what that means or why they feel better is only poorly understood. The rest
of the patients are sent on their way. There appear to be few follow-up
studies on the majority of families who cases are unfounded. We do not know
how many of them suffered morbidity due to surgical trauma or post-surgical
infection or as a result of undetected or untreated disease.

Hence we have a system in the throes of its own crisis of legitimacy. Some
claim it doesn't do enough to protect children. Others claim that it
violates families and the rights of parents. (Remember, the unfounding rate
is nearly 66 percent in the state where I work. We can argue over what that
figure means, but it is large. Imagine any other public health test with a
"false-positive" rate that high.)

What can be done to resolve the crisis? Here are some of the recommendations
that I'm considering:

1) Integrate child protective services and preventive services for children
and families. Don't force all requests for service and assistance to go
through the "child abuse" door (as is now pretty much the case); rather, cull
out the abuse cases when you're close enough to make a reliable assessment.
(In the state where I work, intake for child abuse is done over the phone.)

2) When considering child abuse, give more definitional weight to harm
resulting from acts that degrade, terrorize, and humiliate children. Why
treat a bruise from a spanking (and spanking is legitimate in *much* of our
culture) the same way you'd treat deep emotional impairment resulting from
continual parental scapegoating? It seems to me a defensible claim that
child abuse, in any culture, is really more about the mental and emotional
destruction of a child, with or without physical harm or impairment, than it
is all "insults to child welfare" (which may be attributable more to poverty,
cultural differences, and accidents). It should be so treated in policy.

3) Link anti-child abuse efforts with community development efforts. Given
the strong correlation between social breakdown and child maltreatment which
appears to hold across all cultures (see Levine and Levine, and Ritchie and
Ritchie in Korbin 1981), it makes a lot of sense.

Here's my question to the list. What do you think of these proposals? (This
is not a loaded question. I can think of counter arguments to all of the
above proposals.) Is it possible to "relativize" child abuse and child
protection in the US (or any other form of vicimization)? Is it possible
devise an integrated services system that "perps" and resolves both the
proximate and ultimate causes of social problems?

Mike Cahill