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Drawing the pain
THE CHILD IN THE COMMUNITY: NURSING MAKES A DIFFERENCE Column Editor: Rita Black Monsen, DSN, MPH, RN
Drawing the Pain Rita Black Monsen, DSN, MPH, RN
T
HANK HEAVENS FOR paper and crayons, sidewalks and chalk, and computer screens and cursors. We know that children will draw what they feel, what they wish for, and what is happening in their lives. Often, they draw what they cannot tell us; they use color and position of family and friends when they cannot explain the complexities of emotion and events around them. Gaffney, Barndt-Maglio, Myers, and Kollar (2002), reporting on assessment for harsh treatment of children, cited a U.S. Department of Health and Human Services report (2000) that estimated that 903,000 children suffer some form of abuse in our country. Peterson, Hardin, and Nitsch (1995) reported findings from several studies of adults that an estimated one in three girls and one in five boys are victimized. They outlined several features of children’s drawings that suggest abuse, pointing to the value of children’s art as an avenue of assessment and possible referral for help. Although child abuse in all of its forms is destructive, perhaps sexual abuse presents the most complex web of pain and emotional upheaval, later evolving into a labyrinth of agony, pleasure, and victimization. This web struck me last year as I read the account of a family on the easternmost shore of Nova Scotia, Fall On Your Knees by MacDonald (1996). The description of a dysfunctional family, early maternal loss, and a father doting on one talented daughter while destroying another was riveting. I could clearly imagine the horror, shame, and suffering felt by the victim and
From Hot Springs, AR. Address correspondence and reprint requests to Rita Black Monsen, DSN, MPH, RN, Independent Nursing Education Consultant, 119 Ledgerwood Circle, Hot Springs, AR 71913. © 2003 Elsevier Inc. All rights reserved. 0882-5963/03/1804-0008$30.00/0 doi:10.1053/S0882-5963(03)00089-7
284
witnessed by others in the family. Indeed, Bernet and Dulcan (1999) outlining the epidemiology, assessment, and interventions for children and adolescents who have become sexually abusive of others, describe the patterns of abuse coupled with arousal that may later become entwined with seeking gratification from victims. Children’s drawings are but one approach to the assessment of those who have been victimized (Thomas & Jolley, 1998) and are at risk for turning on others (Bernet & Dulcan, 1999), they have been recognized as an informative resource for capturing experiences that might otherwise never come to light (Carroll & Ryan-Wenger, 1999; Stein, 2001). Often, nurses are able to discern signals from children and their families that indicate deeper turmoil. Children can be encouraged to draw themselves and their families, and tell about what they have depicted. They might draw a family event, a celebration, or a holiday get-together and explain how they and others in the picture felt. Although the majority of these drawings will be innocuous, even whimsical; the alert clinician might be able to identify sadness and pain in some, if children in risky circumstances are given the opportunity to express their feelings. Being open and supportive, and ensuring appropriate follow-up to community resources for the child and family are essential. We certainly wish that all children would have healthy development, family lives filled with warmth and safety, and communities that offered opportunities for education, work, and participation in the political process. We know that most families are dysfunctional and most communities do not have adequate resources to provide adequately for our children. Perhaps among our priorities should be programs that protect abused children. If we do not have satisfactory rehabilitation
Journal of Pediatric Nursing, Vol 18, No 4 (August), 2003
DRAWING THE PAIN
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facilities for victimizers, we should provide for training of providers who serve our youth and public education campaigns to disseminate infor-
mation about abuse prevention and treatment. After all, what is more worthwhile than funding programs that interrupt cycles of violence?
REFERENCES Bernet, W., & Dulcan, M.K. (1999). Practice parameters for the assessment and treatment of children and adolescents who are sexually abusive of others. Child & Adolescent Psychiatry, 38(Suppl.), 55S-76S. Carroll, M.K., & Ryan-Wenger, N.A. (1999). School-age children’s fears, anxiety, and human figure drawings. Journal of Pediatric Health Care, 12, 24-31. Gaffney, K.F., Barndt-Maglio, B., Myers, S., & Kollar, S.J. (2002). Early clinical assessment for harsh child discipline strategies. MCN, The American Journal of Maternal/Child Nursing, 27, 34-40. MacDonald, A. (1996). Fall on your knees. New York: Simon & Schuster. Peterson, L.W., Hardin, M., & Nitsch, M.J. (1995). The use of children’s drawings in the evaluation and treatment of child
sexual, emotional, and physical abuse. Archives of Family Medicine, 4, 445-452. Stein M.T. (Ed.). (2001). The use of family drawings by children in pediatric practice. Journal of Developmental & Behavioral Pediatrics, 22(Suppl.), S49-S54. Thomas, G.V., & Jolley, R.P. (1998). Drawing conclusions: A re-examination of empirical and conceptual bases for psychological evaluation of children and their drawings. British Journal of Clinical Psychology, 37, 127139. U.S. Department of Health and Human Services. (2000). Child maltreatment 1998: Reports from the states to the National Child Abuse and Neglect Data System. Washington, DC: U.S. Government Printing Office.
Drawing the Pain Rita Black Monsen, DSN, MPH, RN
T
HANK HEAVENS FOR paper and crayons, sidewalks and chalk, and computer screens and cursors. We know that children will draw what they feel, what they wish for, and what is happening in their lives. Often, they draw what they cannot tell us; they use color and position of family and friends when they cannot explain the complexities of emotion and events around them. Gaffney, Barndt-Maglio, Myers, and Kollar (2002), reporting on assessment for harsh treatment of children, cited a U.S. Department of Health and Human Services report (2000) that estimated that 903,000 children suffer some form of abuse in our country. Peterson, Hardin, and Nitsch (1995) reported findings from several studies of adults that an estimated one in three girls and one in five boys are victimized. They outlined several features of children’s drawings that suggest abuse, pointing to the value of children’s art as an avenue of assessment and possible referral for help. Although child abuse in all of its forms is destructive, perhaps sexual abuse presents the most complex web of pain and emotional upheaval, later evolving into a labyrinth of agony, pleasure, and victimization. This web struck me last year as I read the account of a family on the easternmost shore of Nova Scotia, Fall On Your Knees by MacDonald (1996). The description of a dysfunctional family, early maternal loss, and a father doting on one talented daughter while destroying another was riveting. I could clearly imagine the horror, shame, and suffering felt by the victim and
From Hot Springs, AR. Address correspondence and reprint requests to Rita Black Monsen, DSN, MPH, RN, Independent Nursing Education Consultant, 119 Ledgerwood Circle, Hot Springs, AR 71913. © 2003 Elsevier Inc. All rights reserved. 0882-5963/03/1804-0008$30.00/0 doi:10.1053/S0882-5963(03)00089-7
284
witnessed by others in the family. Indeed, Bernet and Dulcan (1999) outlining the epidemiology, assessment, and interventions for children and adolescents who have become sexually abusive of others, describe the patterns of abuse coupled with arousal that may later become entwined with seeking gratification from victims. Children’s drawings are but one approach to the assessment of those who have been victimized (Thomas & Jolley, 1998) and are at risk for turning on others (Bernet & Dulcan, 1999), they have been recognized as an informative resource for capturing experiences that might otherwise never come to light (Carroll & Ryan-Wenger, 1999; Stein, 2001). Often, nurses are able to discern signals from children and their families that indicate deeper turmoil. Children can be encouraged to draw themselves and their families, and tell about what they have depicted. They might draw a family event, a celebration, or a holiday get-together and explain how they and others in the picture felt. Although the majority of these drawings will be innocuous, even whimsical; the alert clinician might be able to identify sadness and pain in some, if children in risky circumstances are given the opportunity to express their feelings. Being open and supportive, and ensuring appropriate follow-up to community resources for the child and family are essential. We certainly wish that all children would have healthy development, family lives filled with warmth and safety, and communities that offered opportunities for education, work, and participation in the political process. We know that most families are dysfunctional and most communities do not have adequate resources to provide adequately for our children. Perhaps among our priorities should be programs that protect abused children. If we do not have satisfactory rehabilitation
Journal of Pediatric Nursing, Vol 18, No 4 (August), 2003
DRAWING THE PAIN
285
facilities for victimizers, we should provide for training of providers who serve our youth and public education campaigns to disseminate infor-
mation about abuse prevention and treatment. After all, what is more worthwhile than funding programs that interrupt cycles of violence?
REFERENCES Bernet, W., & Dulcan, M.K. (1999). Practice parameters for the assessment and treatment of children and adolescents who are sexually abusive of others. Child & Adolescent Psychiatry, 38(Suppl.), 55S-76S. Carroll, M.K., & Ryan-Wenger, N.A. (1999). School-age children’s fears, anxiety, and human figure drawings. Journal of Pediatric Health Care, 12, 24-31. Gaffney, K.F., Barndt-Maglio, B., Myers, S., & Kollar, S.J. (2002). Early clinical assessment for harsh child discipline strategies. MCN, The American Journal of Maternal/Child Nursing, 27, 34-40. MacDonald, A. (1996). Fall on your knees. New York: Simon & Schuster. Peterson, L.W., Hardin, M., & Nitsch, M.J. (1995). The use of children’s drawings in the evaluation and treatment of child
sexual, emotional, and physical abuse. Archives of Family Medicine, 4, 445-452. Stein M.T. (Ed.). (2001). The use of family drawings by children in pediatric practice. Journal of Developmental & Behavioral Pediatrics, 22(Suppl.), S49-S54. Thomas, G.V., & Jolley, R.P. (1998). Drawing conclusions: A re-examination of empirical and conceptual bases for psychological evaluation of children and their drawings. British Journal of Clinical Psychology, 37, 127139. U.S. Department of Health and Human Services. (2000). Child maltreatment 1998: Reports from the states to the National Child Abuse and Neglect Data System. Washington, DC: U.S. Government Printing Office.