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Breaking Point
BOOK FORUM Schuyler W. Henderson,
MD, MPH
Assistant Editor
Breaking Point
T
he amazing, horrific thing about the damage people do to other people is that it is so often not accomplished through a single spectacular act—although we do enough of that—but is an ongoing process of degradation and hurt. In our field in particular, we see the consequences of the damage that comes from a pervasive, global adult willingness to break children. An underlying theme in this Book Forum is the way in which we are spectators to this process. Spectatorship is a theme of the anecdote opening Zeanah’s review and is, of course, an underlying theme in the work of Bennet Omalu, whose book describing his discovery of chronic traumatic encephalopathy in American football players is reviewed by Prabhakar and Akinyemi. We are watching violence unfold before our eyes, and maybe we are “intervening” and maybe we are ignoring it because it is all just so exciting, but can we actually stop it from happening again? In our work, we are often looking at how we can effect change in another person, but the questions posed this month are really about how we can effect change in ourselves so that we can move from spectatorship to the kind of lasting action that will decrease the amount of violence and suffering in the world. Given how hard it is to change our world after spectacular acts of damage (think of the failure to enact basic gun control after school shootings), it is no wonder that we can feel so helpless in the face of the chronic grinding cruelty that picks at and slowly breaks so many of the children we work with and the myriad diffuse pressures that crush them from every direction. The books in this month’s Book Forum offer tentative models for replacing a passive, helpless spectatorship with something more constructive and effective. Disclosure: Dr. Henderson reports no biomedical financial interests or potential conflicts of interest. http://dx.doi.org/10.1016/j.jaac.2016.10.017
Broken Three Times. A Story of Child Abuse in America. By Joan Kaufman. New York: Oxford University Press; 2016.
JOURNAL OF THE AMERICAN ACADEMY OF C HILD & ADOLESCENT PSYCHIATRY VOLUME 56 NUMBER 2 FEBRUARY 2017
I
am sure you have heard the following story, or some version of it. I first heard it from Irving Harris, but that was before you could find it through Googling. Anyway, the story goes like this. One day, a man spots a young child drowning in the river. He jumps in and saves the child. The next day, there are two children drowning, and he jumps in again and saves them. The following day, there are four children drowning, and several people jump in to try to save them. The man who saved the first three, however, does not jump in the river. In fact, he runs away. His friends say to him, “Wait, where are you going?” He shouts over his shoulder as he runs, “I am going up the river to see who is throwing the kids in.” In Joan Kaufman’s remarkable new book, she gives us a perspective from which to consider how we try to help “drowning” children and how our limited perspective hampers our efforts. To do this, she tells the real-life story of a family, a mother and two children. Kaufman, as you probably know, is one of the world’s leading researchers on child maltreatment. She met this family in the course of their participation in her studies and never had any clinical role with them. Still, it is clear that she spent many hours with them to make this book possible, and her care and concern for them could not be greater even if she had been their clinician. The children (and their mom) have histories of abuse, neglect, and exposure to violence, and the children spent most of their adolescence in foster care. The central story reads like a novel, placing the reader uncannily in the children’s lives and heads as the story unfolds. This creative nonfiction approach brings this real family to life in a way that case studies typically do not. How many times have I read or written about the importance of context in children’s development? Here it is in all of its shocking, raw, and compelling reality. The story begins (appropriately) with a tragic vignette about the mom’s own childhood, before skipping ahead to her as an adult with two children who need more than she is able to provide, despite her clear love for them. Each chapter, drawn from Kaufman’s research records, from files in Child Protective Services, and from extensive interviews with those involved, tells a part of the children’s story, as they are taken into and ultimately released from “the system.” At the conclusion of each chapter, Kaufman-thebiographer becomes Kaufman-the-professor, discussing the literature about a topic relevant to the events described in that chapter. Topics include domestic violence, substance abuse, racial disparities, placement disruptions, abuse in foster care, the serious problems of group care, and others. These brief discussions are enormously informative. For the past 22 years, I have spent about 2 days a week in a
www.jaacap.com
175
MD, MPH
Assistant Editor
Breaking Point
T
he amazing, horrific thing about the damage people do to other people is that it is so often not accomplished through a single spectacular act—although we do enough of that—but is an ongoing process of degradation and hurt. In our field in particular, we see the consequences of the damage that comes from a pervasive, global adult willingness to break children. An underlying theme in this Book Forum is the way in which we are spectators to this process. Spectatorship is a theme of the anecdote opening Zeanah’s review and is, of course, an underlying theme in the work of Bennet Omalu, whose book describing his discovery of chronic traumatic encephalopathy in American football players is reviewed by Prabhakar and Akinyemi. We are watching violence unfold before our eyes, and maybe we are “intervening” and maybe we are ignoring it because it is all just so exciting, but can we actually stop it from happening again? In our work, we are often looking at how we can effect change in another person, but the questions posed this month are really about how we can effect change in ourselves so that we can move from spectatorship to the kind of lasting action that will decrease the amount of violence and suffering in the world. Given how hard it is to change our world after spectacular acts of damage (think of the failure to enact basic gun control after school shootings), it is no wonder that we can feel so helpless in the face of the chronic grinding cruelty that picks at and slowly breaks so many of the children we work with and the myriad diffuse pressures that crush them from every direction. The books in this month’s Book Forum offer tentative models for replacing a passive, helpless spectatorship with something more constructive and effective. Disclosure: Dr. Henderson reports no biomedical financial interests or potential conflicts of interest. http://dx.doi.org/10.1016/j.jaac.2016.10.017
Broken Three Times. A Story of Child Abuse in America. By Joan Kaufman. New York: Oxford University Press; 2016.
JOURNAL OF THE AMERICAN ACADEMY OF C HILD & ADOLESCENT PSYCHIATRY VOLUME 56 NUMBER 2 FEBRUARY 2017
I
am sure you have heard the following story, or some version of it. I first heard it from Irving Harris, but that was before you could find it through Googling. Anyway, the story goes like this. One day, a man spots a young child drowning in the river. He jumps in and saves the child. The next day, there are two children drowning, and he jumps in again and saves them. The following day, there are four children drowning, and several people jump in to try to save them. The man who saved the first three, however, does not jump in the river. In fact, he runs away. His friends say to him, “Wait, where are you going?” He shouts over his shoulder as he runs, “I am going up the river to see who is throwing the kids in.” In Joan Kaufman’s remarkable new book, she gives us a perspective from which to consider how we try to help “drowning” children and how our limited perspective hampers our efforts. To do this, she tells the real-life story of a family, a mother and two children. Kaufman, as you probably know, is one of the world’s leading researchers on child maltreatment. She met this family in the course of their participation in her studies and never had any clinical role with them. Still, it is clear that she spent many hours with them to make this book possible, and her care and concern for them could not be greater even if she had been their clinician. The children (and their mom) have histories of abuse, neglect, and exposure to violence, and the children spent most of their adolescence in foster care. The central story reads like a novel, placing the reader uncannily in the children’s lives and heads as the story unfolds. This creative nonfiction approach brings this real family to life in a way that case studies typically do not. How many times have I read or written about the importance of context in children’s development? Here it is in all of its shocking, raw, and compelling reality. The story begins (appropriately) with a tragic vignette about the mom’s own childhood, before skipping ahead to her as an adult with two children who need more than she is able to provide, despite her clear love for them. Each chapter, drawn from Kaufman’s research records, from files in Child Protective Services, and from extensive interviews with those involved, tells a part of the children’s story, as they are taken into and ultimately released from “the system.” At the conclusion of each chapter, Kaufman-thebiographer becomes Kaufman-the-professor, discussing the literature about a topic relevant to the events described in that chapter. Topics include domestic violence, substance abuse, racial disparities, placement disruptions, abuse in foster care, the serious problems of group care, and others. These brief discussions are enormously informative. For the past 22 years, I have spent about 2 days a week in a
www.jaacap.com
175