Overwhelmed With Weird

I think I need my head examined.

Since today kept getting more and more bizarre, I just had to chill out with a movie.  A movie that my psychologist suggested that I watch with my son, way back when he was (WAS!!!) dating a woman with Borderline Personality Disorder, who called him every thirty seconds and texted him in between calls, and became irate when he didn’t return her texts while he was in meetings.  My bone-chilling fear was that she would manage to get pregnant…….but thank G-d she did not, and at last he developed, through hard work, the strength to finally leave her.

The movie, of course, is Fatal Attraction.

My skin is still crawling.

I must be having a masochistic spell, or I certainly wouldn’t have pulled that one out of the hat.  Or maybe I just needed to see something weirder than my real life, these days.

Dad is doing much better now that he’s home from the nursing home.  Mom is busy working on that, though, by encouraging him to stand up by himself in the bathroom (that’s when he falls down–when he’s standing up, because he can’t feel his legs, and the tile floor is always hard).  ‘Round and ’round and ’round she goes, and where she stops, nobody knows.

I’m glad Dad is better.  We get to spend more quality time together.  After I gave him his lunch today, we had tea.  He wanted a really strong tea, so he chose Irish Breakfast, and I had Earl Grey.  As we shared our tea, conversation floated naturally from one topic to another.  Then, on his way to the cookie jar, he fell asleep in his wheelchair, and I let him nap in peace.

My mother came in from shopping with her usual flourish, braying for the cat and waking Dad, which is hard to do.  I waited until everything was settled down, and gathered my things to go.

As I was getting ready to leave, and before I had a chance to put my raincoat on, she slapped me on the arm…hard.

 Memories of stinging childhood slaps.

“Don’t hit me!” I yelled.

“Why not?  I can hit you if I want to.  You’re my child!” Smirked Mrs. Social Worker Guardian-Ad-Litem.

“Parents who hit their children get reported to Social Services.  Remember?”  My mouth said it, but my mind was numb.

“Oh.  Yes,” she said blankly.

So I go home and watch Fatal Attraction.

What a jerk.

I. Am. On. The. Wrong.  Planet.  Phone home.

The Sword of Damocles

Every time the phone rings I dread it.  The several times a week that I see her sour face, I cringe.  It’s happened!  She’s found my blog!   My mother, that is.

I’ve written my heart out on the topic of the rage that seethes within me at the very thought of her.  Of the abuse that I suffered at her hands as a child, and that I have continued to suffer as an adult.

Because of her I became a teenage runaway, to escape her endless screaming, name-calling, belittling, gas-lighting, accusations of imagined crimes.

Because of her I preferred sleeping outdoors or in abandoned buildings, suffering  hunger, cold, and turning to prostitution in order to survive.

And when I tried over and over and over again to make amends for the crime of  having left “home” she drove me out with curses: “You’re shit!” she would calmly observe. “You’re good for nothing!”  And once again, I fled in tears, into the forest, into the arms of any waiting man who seemed to want me, into cocaine, into the underworld of dirty Chicago….anywhere but “home.”  I don’t have a “home.”  She threw me out of it.

So I started getting degrees, to prove to myself that I was good for something.  And maybe if I was good for something, she would love me.  A bachelor’s. An M.D., with a master’s tacked on for good measure.  Head of my class, 5.0 GPA, wall full of awards.  Exercised and starved myself into ultimate shape.  Made a lot of money, legally.  Sent expensive gifts.  All-expense-paid-for vacations.  Surely that would earn me favor in her eyes?  Surely now she would see what a good daughter I was?

It did, sort of.  She sang my praises far and wide, in the public sphere.  But in private, again: “You moron!  Don’t you know anything?  How could you be so stupid!”

Yes, I know she’s crazy.  She comes from a family of crazies. I know the stories of what she did to me when I was a baby, a toddler, and how the family laughed about it, and how she said I deserved it: always getting into mischief, that one.

So I’m terrified that she will find my blog, and read what I have written about her.  She will not think: “Oh my God, what have I done to cause my only child to fear me so?  How can I fix this, how can I change, how can I make amends?”  No, she won’t think that.  She will think:  “Why, that g_d-damn  stinking little selfish bastard!  She can’t stand me, eh?  Well she’ll get hers!  I’ll give her something to fear!”  And she will.

Thirty years of therapy have not erased the trauma.  I still feel like that helpless little kid being cut to ribbons by her sharp tongue.  Some wounds don’t heal.

Searching For the Missing Me

I am sitting in the kitchen of my beloved friend R_, who was on the same flight with me when we made Aliyah (emigrated) to Israel in 2007.  We didn’t meet on the plane because he was in such ecstasy at moving to our real home country that he didn’t notice anything around him.  He was in a haze of love and joy.  I met him about four months after our arrival.  He was hanging out laundry on his mirpesset (balcony), and I recognized him from the flight.  His place turned out to be exactly one block from mine, and my seat-mate on that flight happened to live exactly one block from him!  The three of us became the best of friends.  R_ has become my support system and champion in my struggle to free myself from the toxic, strangulating tentacles that have torn me from my real home country and dragged me back to America, which otherwise holds no attraction to me.

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R_’s living room

I had to take a break from my parents and America, because I found myself consumed with rage, which is a very unhealthy emotion.  I developed high blood pressure and heart palpitations, and was having terrible heart pains that woke me out of sleep.  They were so intense that I could not even move to call an ambulance, even had I wanted to, which I didn’t.  I would have been just as happy if a heart attack carried me off, out of the misery of my life there.

So I suddenly announced that I was going to Israel for three weeks, for a break, causing immense consternation on the maternal side of things, and resignation from the Dad side.  I needed a breathing spell, and specifically to breathe the air of the Holy Land, just to be here, even if all I did was to hang out with my friend R_ and walk around the shuk, inhaling and imbibing the sights, sounds, smells, and spirit of the place.

Bride and groom playing in the shuk

Bride and groom playing in the shuk

Practically as soon as I got off the plane my Israeli cell phone started ringing:  “We’re so glad you’re back: now everything feels normal again.”  I have a place, and my place is here.    My family of choice lives here.  I feel surrounded by love here.

R_ and I went yesterday to visit the tomb of the Baba Sali, a holy man who was said to have brought about many miracles in his time.  Here it is customary to visit the tombs of great and wise people (like Abraham, Isaac, Jacob, Rachel, Leah, Samuel, etc.) to bathe in their energy and pray for whatever needs prayed for.  We don’t pray to the person, for that is idol worship, but instead we pray for the spirit of that holy person to intercede for us in Heaven so that our prayers will be heard.  I had, and still have, a lot to pray for, so we went to the Baba Sali, because I have a special connection with him.

Baba Sali lived in our times, and came from Damascus to Morocco to Israel, where he settled in a tiny village called Netivot, which is located in the Negev desert right on the border with Gaza, just south of Sderot, which is a town that has been rained on with so many thousands of missiles from Gaza that every bus stop has its own bomb shelter.

Why do I feel safe here?  Right now, at this very moment, Russia is funneling terrible weapons into Syria, which in turn is passing them on to Hezbollah (the terrorist arm in Lebanon), Iran is arming Hamas in Gaza, the West Bank, and Lebanon, and all of them are fighting among themselves.  It’s a virtual certainty that they will attack Israel at some point.  On Monday and Tuesday this week the air raid sirens went off in every town in the Land, and everyone was supposed to drill taking shelter.  Nobody did, because Israelis are used to being the objects of the aggression of our neighbors, and we realize that only G-d can save us, since we are a country the size of Delaware, so we go on with our lives and our prayers, and of course we hope that rockets won’t fall on our houses or our children, but we rely on G-d to be our shelter.  No Westerner can understand that.

But that’s not what this blog entry is about.

It’s about the terrible conflict that tears me apart, and keeps me from living the life I love, the life the holds out the possibility of real spiritual redemption.  It’s about the conflict between kibud av v’aim, respect for father and mother, which is one of the Ten Commandments.  The letter of  halacha, Jewish Law, interprets this to mean that one is obligated at minimum to provide shelter, food, and clothing sufficient for one’s parents’ needs, but I have a hard time with leaving it at that.

Although my mother severely abused me emotionally, psychologically, verbally, and at times physically, and my father was a codependent facilitator, I still have difficulty separating from them completely, because I continually hope that they will magically become the parents I have always desperately wanted and needed:  loving, caring, nurturing, and deserving of my love and respect.

In fact, in my adolescent confrontational phase, before I picked up and left home at age 16, my mother would scream at me, “You have to love and respect me because I am your parent.”  And I would scream back, “If you want me to love and respect you, you have to earn it,” to which the dear mother would generally reply with a stream of obscenities and a smack across the face, if she could reach me.

So why, after four years of blissful content in Israel, did I rush to their side when their time of need arrived in their old age?  And what has kept me there, in total isolation and spiritual desolation, for two and a half years?  Unconditional love,  blind even to ongoing abuse?  Kibud av v’aim?   Or that desperate primal hope that one day I would awaken to find them magically transformed into my real parents, the ones who dropped me off here on this alien planet 59 years ago?

I just don’t know.

alien woman head

Interview With Ruth Jacobs, Author and Anti-Trafficking Activist

I’m excited to have a guest on board here at Bipolar For Life:  Ruth Jacobs, author of the upcoming best-selling novel series Soul Destruction.  Part one of the series, Soul Destruction: Unforgivable, will be released worldwide on April 29, 2013.

Ruth Jacobs no border

Soul Survivor: Ruth’s gritty, hard-hitting novel features a more-or-less close-knit group of friends who have at least two things in common: drugs, and prostitution.  So what is this book doing on my blog, which tries its best to stay focused on mental health and child abuse issues?  Probably because this group of tough customers has more than just two things in common.

Let’s read a passage from Soul Destruction: Unforgivable, and then we can ask Ruth to help us understand.

Aunt Elsie made tea and they sat on their usual white stools at the white, plastic table in the kitchen. Elsie, as always, sat facing the back door and Shelley, facing the hall. From her chair, she could see the picture frames that stood on the hall table. Although she couldn‘t see the pictures, she knew each one from memory. The pictures were of happier times: baby pictures of her and William, a school picture of William when he was about ten, a school picture of Shelley taken around the same time, putting her at seven or eight, and a picture of them both with their mother before she became ill. That last picture, taken in Brighton in the summer of 1983, was from the last holiday they‘d had with just the three of them. Until that year, Rita had taken her and William to Brighton every summer. Neither she nor her mother had been back since, but William had, once.

Shelley gulped her tea and apologised to her aunt for the short visit. On her way to the front door, she stopped at the hall table. It was the missing pictures she noticed. There was no record from that last holiday until she was fifteen years old and William was seventeen. As if those years in between had never existed. Of course, they had. They all wanted to forget them. But how could she erase them when she‘d endured them? However much she tried, those years wouldn‘t stop replaying in her head. That‘s what caused the rage, the despair, and the excruciating pain that fed on her soul.

S/S: Ruth, this passage starts out looking pretty normal.  I mean, prostitutes don’t have aunts named Elsie with whom they have tea every week, do they?  What, you’re telling me that prostitutes are people like you and me?  Shocking.  But wait, reading on, we find that things are not so happy as they once were.  There seems to be a skeleton in the family closet, perhaps?

You and I have had some conversations regarding prostitution and what might set the stage for a girl or woman to become caught up in it.  Can you talk a bit about that, in the context of the passage we’ve quoted?  What is it here that might have propelled Shelley in the direction she’s taken?   Something happened, didn’t it, something terrible, it seems….

Ruth: Yes, something terrible did happen. I don’t want to give any spoilers about the book for people who will be reading it, but I think it’s very important to know that a large percentage of people in prostitution have a history of being abused as children, whether that be physical and/or sexual abuse. Childhood abuse can set them up as targets for pimps and traffickers. Many women in prostitution started as children. Children do not make these choices. They may be forced by another, they may be homeless, as some I know have been, and out of desperation for a roof over their head for a night or something to eat, they turn to prostitution. For some they have been treated and viewed as sex objects and feel that is their worth. There are more complexities in this, and studies and research into the links between childhood abuse and prostitution have been conducted. For anyone who would like to understand more, my dissertation on prostitution, which I undertook back in the late 1990s, can be read freely here http://soul-destruction.com/on-prostitution.

S/S: Let’s go on to another scene from your book.

Emotionally exhausted, Shelley slept until a nightmare woke her late afternoon. Swaddled in her favourite duvet, she shuffled along the cold, black and white floor tiles in the kitchen. She poured a glass of water and took it through to the lounge. She landed herself on the sofa, then picked up one of her new, sparkling dessert spoons and began cooking up her fix.

What she‘d heard from Tara yesterday shocked her. Not that another call girl would have a past like that, most of the hookers she knew did. The shock was that Tara knew what she had gone through as a child, yet hadn‘t confided in her. Was it her fault Tara had never been able to tell her? Possibly not – Tara hadn‘t told Nicole either. But Shelley knew she could have been a better friend. There were things she could have done differently, things she could have said differently, and things she could have not said at all. She remembered the cruel words she‘d spoken the day before.

Guilt grew from her gut and permeated her body. Her breathing shallowed. This had to be a big hit. It would take more heroin and crack than usual to change this feeling. This feeling on top of her grief, her anger, and her fears had done more than add to them. It felt as if they‘d all been amplified. The noise had to be muted.

The speedball she‘d prepared was overgenerous but essential. She needed to get to nirvana. Without a tourniquet, she squeezed her wrist and went straight for a visible vein in her hand.

She fell back on the sofa and thought this time she might die. This was overdose territory. She lost control of her body as she convulsed. She tried to scream for help but no words came, not recognisable words. She could hear herself babbling but couldn‘t tell if she was making those sounds or if they were coming from inside her head.

S/S: Now we’re hearing Shelley’s shock upon finding that her friend Tara, too, has things hidden in her past, things that she’s been unable to speak about, and Shelley’s over-amplified guilt at seeing herself as not having been a better friend.

Ruth, why would that upset Shelley to the point where she nearly kills herself to get away from the pain?

Ruth: It’s not that alone that brings Shelley to this point. Already being in an extremely dark place, the situation with Tara tips her over the edge. Shelley carries guilt that does not belong to her, as many survivors of abuse do, whether that be childhood abuse or being raped as an adult, for example. This victim-blaming culture perpetuates that. For example, when a woman is raped, some people will blame that rape on what she was wearing, whether she was drunk or had taken drugs, if she was out late at night alone etc. The rape is the fault of the rapist and no one else.

Shelley is a sensitive, kind and caring young woman. She is quick to take on responsibility for caretaking others, as she had as a child within her family, and still does during the time the novel is set in her early twenties. She feels inadequate, not good enough, in many ways. From being at the receiving end of abuse in her childhood and the negative messages that go along with that, she speaks to herself in that same way. In transactional analysis, a branch of psychiatry, it is said we have three ego states: parent, adult and child. The parent ego state is formed by what we hear from our parents/guardians as children. If they are berating when we are children, those ‘recordings’ play out in our heads as adults. It is possible to change these, but I have struggled with it myself.

S/S: So how does child abuse feed into prostitution?  What percentage of prostituted women were abused as children?  Is there a differential between different types of abuse, like physical, emotional, or sexual?  Does that matter?

Ruth: Various studies have been conducted in this. The figure I have from my dissertation is that 75% of women in prostitution have been victims of childhood sexual and physical abuse (WHISPER Oral History Project, 1987). A more recent UK study revealed that 45% suffered sexual abuse and 85% suffered physical abuse within their families (Home Office 2006).

From my personal experience of knowing many women in prostitution and many who have exited, all those I have discussed childhood abuse with have suffered that themselves. I have also known some men in prostitution, though only a few, and again, all those who I discussed childhood abuse with had suffered that too. Some people in prostitution have suffered emotional and verbal abuse in childhood. And there are some who will not have suffered abuse as children. But there is clearly a very strong link between childhood abuse and prostitution.

S/S: Thanks so much, Ruth, for helping us to understand some links between childhood abuse and prostitution.  As a pediatrician and adolescent medicine specialist, I saw many young people who had ended up on the streets doing whatever they needed to do to stay alive.  Many of them had to resort to prostitution just to buy food and have a place to stay at night, although many were homeless, largely due to drug addiction that ate up all their money.  When they came into my clinic, I had a golden opportunity to talk with them and ask about why they were out on the streets instead of living at home.  Many cited “mom’s boyfriend” who was either currently sexually abusing them or trying to.  Others spoke of ongoing physical abuse since early childhood; others said that their parents “just didn’t care about them and they felt better just being on their own.”  Often, I just couldn’t hold my tears back and sometimes they cried too, although most had trained themselves to have a tough exterior, out of necessity.

More about Ruth Jacobs and her writings:

Soul Destruction: Unforgivable

SD-front border 

Enter the bleak existence of a call girl haunted by the atrocities of her childhood. In the spring of 1997, Shelley Hansard is a drug addict with a heroin habit and crack psychosis. Her desirability as a top London call girl is waning.

When her client dies in a suite at The Lanesborough Hotel, Shelley’s complex double-life is blasted deeper into chaos. In her psychotic state, the skills required to keep up her multiple personas are weakening. Amidst her few friends, and what remains of her broken family, she struggles to maintain her wall of lies.

During this tumultuous time, she is presented with an opportunity to take revenge on a client who raped her and her friends. But in her unbalanced state of mind, can she stop a serial rapist?

 

Soul Destruction: Unforgivable is released 29 April 2013. Available worldwide from all major online retailers in paperback and e-book. Pre-orders are available direct from Caffeine Nights

Further information and contact details:

 Ruth Jacobs’s Amazon author page –

UK: http://www.amazon.co.uk/Ruth-Jacobs/e/B008O

US: http://www.amazon.com/Ruth-Jacobs/e/B008OJ0ZMC

Soul Destruction website: http://soul-destruction.com

Author Website: http://ruthjacobs.co.uk

Ruth Jacobs Bio

 Ruth Jacobs writes a series of novels entitled Soul Destruction, which expose the dark world and the harsh reality of life as a call girl. Her debut novel, Soul Destruction: Unforgivable, is released on 29 April 2013 by Caffeine Nights. Ruth studied prostitution in the late 1990s, which sparked her interest in the subject. She draws on her research and the women she interviewed for inspiration. She also has firsthand experience of many of the topics she writes about such as posttraumatic stress disorder, rape, and drug and alcohol addiction. In addition to her fiction writing, Ruth is also involved in non-fiction for her charity and human rights campaigning work in the areas of anti-sexual exploitation and anti-human trafficking.

National Child Abuse Awareness Month: Verbal and Psychological Abuse

Child Abuse Can Be Prevented

Child Abuse Can Be Prevented

“You’re nothing.”  “You’re useless.”  “You’re shit.”  “Can’t you do anything right?”  ‘Well if you don’t know, I’m certainly not going to tell you.”  “You couldn’t find your ass with both hands and a flashlight.  (laughter)”  “You’re too sensitive.”  “Grow some skin/a thicker skin.”  “Fat ass.”

Just a few of the loving epithets hurled at me daily.  I never did grow that “thicker skin,” so I always dissolved in tears and ran out the door, if the weather was good, or up to my room to hide under the covers while the rage downstairs continued with slamming cupboard doors and curses muttered and shouted in mounting fury.

I know what it’s like to go on tiptoe, to see what the “mom weather” is like at the moment, and how to disappear quickly.

I know how to appease the rabid beast, by bringing bribes of flowers and candy and “I love you” handmade cards.

I know how to avert the armageddon, at least temporarily, by making a surprise dinner (although since I allegedly did not know how to do dishes, and this was a thing so simple that any idiot could do it and therefore I should not need to be taught, unless of course I was an idiot, dinner could be a shark tank).

I know how to have suicidal fantasies.  In fact, I know how to commit suicide.  I just haven’t done it.  Yet.

I know how to get straight “A’s” in school in order to please her.

I know how to get a bachelor’s degree, a master’s degree, and a Doctor of Medicine degree, to please her.

I know how to run away from home, when the pain got too much:  first, at age 16, to the other side of the country; and later, at age 50, to the other side of the world.  Both helped for a while.

And yet: and yet….even now, when she is 86 years old and I have dragged myself out of my personal heaven in Jerusalem to help her, one word, one look, and I am that terrified child, nauseated, shaking with terror and homicidal rage.

I have touched her twice: once when I was 16 and she had seized hold of me when I was doing the dishes wrong…I grabbed her by the wrists, wrenching her clawing hands off of me and pinning her against the wall of the kitchen.  She spit, struggled, kicked at me, but I held her till she went still and met my eyes.  I could feel my eyes burning into hers and knew I had won that round, the first and the only.  I threw myself away from her and ran out the back door, not daring to come in until after dark and my father was home.

The second time happened only a few years ago.  We were sitting at the dining room table.  I don’t remember what set her off, but she grabbed my forearm with her claws, and I grabbed her wrist and ripped it off my arm and threw it away from me.  She continued as if nothing had happened.  I desperately wanted to pound her into mush, but I swallowed my rage and pretended there was nothing wrong.  Nothing at all.

Maybe I am thinking of these things, not only because of my Child Abuse series, but because the anniversary of my last failed relationship is coming up.

My psychologist, who I have known for ten years (and perhaps more importantly, has known ME for ten years) and who has seen me through a number of relationships, tells me that a healthy man would not feel right to me because I don’t know what a healthy relationship is.  At first gasp that seems like a negative thing to say, doesn’t it?  But really it’s quite true.  I grew up with a harpy for a mother, and a father who, although I love him dearly, was quite content to step aside and let the chips fall where they might, and hand me his handkerchief afterwards to dry my tears, making excuses for my mother:  she had her period, she was having a hard day, blah blah blah.

Years later when I was in my Pediatrics residency there were posters everywhere that showed a little girl curled up in a corner crying, and a caption that said, “Words can hit harder than a fist.”  I remember looking at those posters, puzzled, wondering what that could mean.  Words can hit harder than a fist.  I actually did not understand the meaning of those words.  In fact, it was not until recently, 25 years later, that the meaning dawned on me.  Verbal abuse can be more damaging than physical abuse.  And I realized why it has taken all these years for me to “get it”:  PTSD.  It was just too traumatic to let into my psyche at that time.  I was not in a safe place, and I had not had the distance from my abuser that would allow me to process that statement: Words can hit harder than a fist.

I am lumping verbal and psychological abuse together for now, because I cannot parse them out.  There are certainly other psychological ways of abusing children (and adults), but from where I am standing at this moment they seem all tangled up together, verbal and psychological and emotional.  I plan to work on this over the next few days and see if I can untangle them, and be more clear.

I know what it is to be confused.

Child Abuse PTSD

Noga the Wonder Dog I really do intend to get through Child Abuse Awareness Month.  And I really do intend to impart what I hope will be useful information, along the way.  It’s just that talking (writing) about child abuse triggers my PTSD to the extent that I am schlepping myself around exhausted, not particularly eating, and not particularly interested in anything much.  And then there are the dreams.  Good thing I have little Noga to keep me entertained with her hijinks and motherly kisses.

I have flashbacks about the little 9 month old who had learned how to turn over and try to wiggle away from having his diaper changed, so his father grabbed him by both legs and gave him a few vigorous shakes, so that he broke both his legs.  That baby turned out to have multiple rib factures in various stages of healing, so it looked like nobody had much patience for him.

Or the little girl who came in from the Souther Tier, always a bad sign.  The Southern Tier is a set of mountains south of Rochester, NY, where things go on that make the movie Deliverance look like Mary Tyler Moore.  This girl kind of stumped us for a while, because of the polka-dot pattern of  three-inch-diameter burns over her whole body.  Her parents, who were filthy, with greasy locks, reeking of beer, were no help at all.  They only brought her in because several of the odd burns had become infected.  One of the professors in the ER that day solved the mystery:  he brought over a light-bulb, and voila! The end of the bulb fit the burns exactly.  The parents eventually admitted that they had been “disciplining” the girl by applying the end of a lit table lamp to her skin.  I’m happy to say the girl was whisked away into the hospital, where she was healed of her physical wounds, and got to do play therapy and art therapy and music therapy and even school, which she had not had the opportunity to attend while languishing in the Southern Tier. She was placed in a good foster home and eventually adopted.

It was not unusual to see intentional injuries that simply don’t compute, at least not to me.  A grandmother “disciplined” her grandbaby by pouring black pepper down the baby’s mouth.  The baby died, and on autopsy was found to have its windpipe completely packed with pepper.  Another grandmother gave her grandbaby an enema of boiling water.  That poor child lived, but had to have five feet of intestine removed, and multiple reconstructive surgeries to try to avoid the year-old baby having to grow up with an ileostomy (wearing a bag on its abdomen to collect stool).  An irate babysitter held a toddler under scalding water in the bathtub, resulting in third-degree burns over 100% of the child’s body.  He died.  And the list goes on and on.

Children chained to their beds, brought in with some incidental illness, and we see the raw and scarred ligature or handcuff marks.  A teenager who was raised in a crawlspace under the house, and was essentially feral, brought in because he had vomiting and diarrhea.  Otherwise, he would have spent his entire life in the crawlspace.

Why did they do these horrible things to their children?  They were bad children, said the caretakers (torturers I say).  Bad children, so they deserved to be burned, imprisoned, tortured, some tortured to death.

I am not crying now, and that is because I dissociate when I think about these things.  But I am making a lot more typing mistakes than I usually do, so that shows that it’s getting through somewhere.  I want to get hold of those parents, grandparents, babysitters, and do the same things to them that they did to their children.  Break their bones.  Burn them with hot light bulbs and lit cigarettes. Etc, etc, etc.  It’s amazing how creative these monsters can be at torturing their children.  We’re not talking getting carried away with a spanking here, we’re talking thinking up things to do to cause grievous physical harm.

The key to avoiding many of these atrocities, I think, starts at birth.  It’s a great time to screen for child abuse risk.  Have a good look at the mother and father.  Watch how they relate to each other.  Watch how the mother relates to her newborn.  Is she in love with her new baby, or does she only want to sleep, and when the nurse brings her the baby to feed, does the minimum required and sends the baby back to the nursery so she doesn’t have to be bothered with it?

Social workers can help immensely, especially if they can make home visits to at-risk families.  There’s nothing like going to someone’s home to get a sense of what really goes on there.  That’s one of the reasons it distresses me that physicians seldom make house calls anymore.  If you only see the baby when the mother (or other caretaker) brings them in for their shots, you really only have a snapshot of what the home environment is like; although let me tell you, some of the routine office visits I’ve had have been hair-raising: if this is how they treat their kids at the doctor’s office, what must it be like at home???

I’ve managed to give you some snippets of what’s causing my child abuse PTSD.  These are only a few of the things I have seen.  I am going to try to soldier on with this, and hopefully manage to navigate through some of the other types of child abuse that damage our children, who grow up to be damaged adults.

National Child Abuse Awareness Month: Statistics

Child Abuse Can Be Prevented

Child Abuse Can Be Prevented

Having not quite recovered from the PTSD triggered by yesterday’s post, I’d like to offer you some sources on child abuse statistics.  They come from reliable sources, e.g. the Childhelp Foundation, which is a very user-friendly but slightly inaccurate source: for instance they estimate that fewer that 10% of children will be victims of sexual abuse, and the actual number is between 20-25%.  Maybe what they mean is that at any point in time 10% are being sexually abused.  I could buy that.  But it’s a good place to start, and gives a broad overview of the societal consequences of child abuse.

The U.S. Department of Health and Human Services’ Child Welfare Information Gateway swings to the other end of the pendulum: way, way too much information for the average bear, but if you are looking for statistics on anything and everything to do with child abuse you will find it here.

If you’re following along with this series, it would be good to take a look at these resources, just to familiarize yourself with the scope of the problem.  You’ll find some astonishing (in a bad way) historical trends over the past decade that make me wonder what kind of pressures are being put on society that causes people to lash out at our most precious possessions, our children.

But are our children really our possessions, or are they placed in our stewardship to raise the way we see fit?  That’s another discussion, isn’t it?  What do you think?

National Child Abuse Awareness Month: Signs of Physical Abuse

Boy am I having a hard time with these posts.  Maybe it’s because I spent 20 years in the trenches as a pediatrician, many of them in the emergency departments of hospitals large and small.  I know I have a hefty case of PTSD from it all, because when I even think of writing these things my stomach goes into a knot and I have an almost uncontrollable urge to bolt.

In today’s post I want to talk about signs of physical abuse that everyone who interacts with children should know about, and be alert for, and know what to do if they see them. I went to my usual source for slides and looked at them, and found that I am no longer capable of looking at color slides of abused children without getting sick.  I guess that’s a good sign, because it means that at least I am no longer capable of dissociating when I look at the patterns of injury.  I had been planning to include some slides with this post, but now I’ve decided I won’t, because they are so heart-breaking that I really don’t want to put them up.

I used to have a slide lecture distributed by my professional organization, the American Academy of Pediatrics, that I took around and showed to teachers, school nurses, volunteer firemen, and anybody else who wanted to hear the talk or who I thought ought to hear it.  I stood up there, brave professional woman, and showed them all these gruesome pictures of inflicted injuries, knowing full well that some of the people in the audience had been abused themselves as children, and that some of them had inflicted injury on their own children.  I must have given that talk well over 50 times, and I never got through one without at least one person in the audience breaking down in tears.  It’s a hard subject.

But even harder is for the subject not to be broached, and for those who are the most likely to be on the front lines of child care to be ignorant of the signs.  How many of us have heard, over and over, about children who have had multiple reports made to Social Services regarding suspected abuse, and the case is neglected, and the child dies?  These children are dying of nothing less than torture.  So if we see or hear something that makes us suspect that a child is being abused, REPORT IT!  Where do we report it?  We usually start with the Department of Social Services, or DSS.  If they don’t act promptly, call 911.  And if you in any way suspect that a child is being abused RIGHT NOW, call 911.

Patterns of Injury

We all know that children run around careening off of every object in their world, including one another, and they all get bruises, cuts, and scrapes; sometimes they even break a bone getting torpedoed off the trampoline or crashing on their bikes.  My own son broke both of his wrists (not at the same time): one by flying over the handlebars of his bike, and the other in an unintentional (on his part) game of roller-derby.  His teacher called DSS on me.  I said, good on her!  Then he broke both of his legs, one getting tackled while playing flag football in sixth grade, and the other playing Varsity football in high school.  Nobody called DSS about those.

There are places that you normally see bruises, scrapes, and cuts: knees, elbows, cheekbones, eyebrows.  Those are the places that stick out and get whacked on inanimate objects.  And the bruises don’t look like anything in particular; they’re usually oval-ish or irregularly shaped.  Cuts are usually jagged and also over bony prominences: how many of you and/or your children have a scar on your eyebrow?  That’s because that’s the part of your face that hits the ground first.  It IS a part that gets hit by a fist first too (besides the nose), but for some reason we see this less in abuse and more in adolescent fights.

So if you see a child who has bruises on the upper arm, as if someone grabbed him, or on her back or the backs of her legs, especially if the marks are linear (as a belt would make) or in loops (electrical cord) or any other pattern, that is very likely inflicted injury.  One interesting exception is the pattern of red marks running parallel to the upper spine that the Oriental folk medicine practice of “coining” makes (rubbing up and down with a coin, usually meant to treat chest congestion), or the circular red marks of cupping, also on the back and sometimes chest.

Babies who are not yet walking, and especially if they are not pulling up on things and falling down, should NOT get bruises.  They don’t do anything that causes bruises!  Bruises can sometimes be accidental, such as a baby rolling off the changing table or couch; in those cases the caretaker is usually frantic with distress over the event and seeks medical care immediately.  That usually (but not always) rules out abuse.  But if you see a slap mark on the baby’s face or anywhere else, that’s abuse.  Bruising on the ears is a red flag for hard slapping.  Bruising over the abdomen can mean internal injuries and must be seen in the emergency department immediately.

Burns

Older kids do get burned, but the cause is always explainable: playing with fire, for instance.  Cigarette burns on an older child signal abuse: that child is probably being abused in other ways also.  Toddlers sometimes get accidentally scalded.  I have seen some horrendous accidental scalds from toddlers pulling electric tea kettles over on themselves.  Since babies’ and toddlers’ skin is so thin, it only takes a moment to produce a full-thickness (third-degree) burn in a small child.  Burns to be concerned about from a child-abuse standpoint are any burn that looks like it has a pattern to it, whether it be the punched-out holes of a cigarette or the “stocking-glove” pattern of a child who is literally dipped into hot water and pushes away with its hands and feet, so that mostly the hands and feet get burned to the same extent.  Some brilliant caregivers get angry with a child who is being potty trained and has an accident, and immerse their bottoms in scalding hot water.  I can’t imagine what goes through these sadists’ minds.  I won’t go through all the varieties of burn patterns, but at this point (if you’re still with me) you get the idea that if there is a pattern to the burns and/or bruises, it’s most likely inflicted injury and must be reported immediately.

Broken bones

It’s hard for a lay person to assess broken bones in patterns of abuse.  One thing that is clear, if you are a caregiver such as a babysitter or a daycare teacher, is that if a baby who was crawling, pulling up, cruising along the furniture or walking, suddenly stops doing this, there’s something wrong.  If the baby simply won’t move a limb or cries when you move it for him, there’s something very wrong.  Report this and don’t be afraid.  Much better to make a report and be wrong than let a baby or child be battered at home.  Amazingly, most small children who come to medical attention for one broken bone are found, on X-ray, to have multiple broken bones in various stages of healing, indicating that this poor child has been repeatedly battered to the point of breaking multiple bones.

One notable exception to the rule that refusal to move a limb means it might be broken is the pesky “nursemaid’s elbow.”  It’s and accidental injury that comes from holding a small child (9 months-3 years) by the hand, and putting tension on the arm, such as swinging the child across puddles (fun!), pulling the child along by the hand because it has suddenly stopped (who has not done this?), or, in the case of my own child, holding the child by the hand and then he suddenly sits down.  Blam!  It pulls the head of one of the two bones in the forearm (the radius) out of its socket, and then it gets stuck and can’t get back in.  My ex-husband was taking my spaghetti-sauce-covered two-year-old son to the sink to wash him off, when my son suddenly sat down, and his screams nearly blew the roof off.  I was an intern at the time, and I had not yet seen a case of “nursemaid’s elbow,” so as we rode to the emergency department I spat all kinds of venom at my ex regarding what I was going to do to him for breaking our child’s arm.  My Pediatrics program director met us at the ER and very kindly explained the innocuous nature of the injury and talked me down from my murderous rage, and showed me how to fix the dislocation (actually it’s a subluxation, but that’s a technicality).  My first case of  subluxation of the radial head, a.k.a. “nursemaid’s elbow.” Some kids have very flexible elbow joints, as did my son: his injury recurred many times, the last time being when he was five years old and was shutting the car door.  The wind caught the door and pulled his radius out and he gave a shriek.  I jumped out and ran around to his side; but by the time I got there he had already fixed it himself.  He was very proud of that, as you may well imagine.

Well, I seem to have managed a few words here on physical abuse.  I may have to take a day or two off now, before I dive back in, as the next topic on the list is sexual abuse; not anything that anyone ever wants to talk about, including me.  But it must and will be talked about.

National Child Abuse Awareness Month: Types of Child Abuse

Child Abuse Can Be Prevented

Child Abuse Can Be Prevented

To tell you the truth, this series is painful for me to write.  For one thing, it’s triggering my PTSD because I was abused as a child.  For another thing, it’s triggering my PTSD because I worked with a child abuse response team member for several years, after which I became an expert witness for a county prosecutor’s office on child sexual abuse.  It’s gut-wrenching work.  But it’s so important to talk about.

For instance, January was Human Trafficking Awareness Month.  I found myself studying the dark pathways by which children end up trafficked into prostitution.  The common thread was abuse at home, which left the youngsters (and I do mean young: the average age of entry into prostitution is 11-14) vulnerable to grooming by “lover-boy” pimps, who take advantage of the girl’s need for love and acceptance, and then funnel them into prostitution.  So sad and wrong.

And that in its turn got me thinking again of the various patterns of abuse that can betray a child’s innocence and indeed rob a child of its childhood completely.

And those patterns of abuse include (and this is by no means a comprehensive list):

1.  Physical abuse, where harm is done to the child’s body with the intent of causing pain;

2.  Sexual abuse, which ranges from inappropriate sexual touching, other sex acts including intercourse, exposure to sexually explicit media, forcing the child to act as a model for pornographic images or video, forcing the child to perform sex acts with others (either children or adults), and more.

3.  Verbal abuse.  I cannot stress strongly enough how terribly destructive verbal abuse is.  It tears down a child’s self esteem and leads to depression and despair, eating disorders, self-harming behaviors, substance abuse, and other self-destructive patterns including suicide.

4.  Emotional abuse.  Typically a push-me, pull-you pattern of drawing the child in through affectionate behaviors and then violently pushing the child away, often using verbal and/or physical abuse.   Emotionally abusing parents will often reverse the parent-child role relationship, so that the child feels responsible for the parent’s well-being.  This is often associated with parental substance abuse.

5.  Psychological abuse.  This is a deliberate program of tearing down a child’s self-esteem for the benefit of building the parent’s ego.  The abusing parent envelops the child in a net of control, holding the reins very tightly, and playing on the child’s emotions as on the keys of a piano.  This type of parent is extremely intelligent, insecure, and is often the product of a highly abusive home.  S/he is highly narcissistic and needs complete control over everything.  Think “Mommy Dearest.”

All five main types of child abuse are forms of torture that produce permanently wounded people.  The extent to which they are able to recover, once out of the abusing environment, seems to depend on the resiliency of their temperament.  I’ve known resilient people who were horribly abused as children, yet grew up to be happy, well-adjusted adults.  And I’ve known less resilient people who’ve ended up so permanently damaged that they fell into addiction and eventually suicide.

What can we do to help?

For one thing, if we have contact with children through our work (teachers, health care workers, day care workers, lunchroom ladies, bus drivers, hairdressers/barbers, etc. etc. you get the idea), we can be on the lookout for telltale signs of abuse, and not be shy about reporting suspicions to the Child Protective authorities.  In fact, certain professionals are mandated to report suspected abuse: teachers, health care workers, and anyone whose job primarily involves children.

In my next post, I will describe some features of each form of abuse, so that you will know what to look for.

National Child Abuse Awareness Month: Shaken Baby Syndrome

Prevent Child Abuse ribbonIn my lifetime, I’ve worn many hats, had many experiences, seen many things, both beautiful and ugly.

As a pediatrician, I’m grateful for the thousands of beautiful yummy babies who have passed through my hands: such a blessing, such a privilege.

As a parent, I’m grateful that I have a beautiful grownup son, who as a child provided me both with joy that surpasseth understanding and with countless sleepless nights.  This in turn provided me with the experience that I needed so that I could properly empathize with the parents of a subset of my patients: the ones that would not sleep.

My beautiful, wonderful son.  I have never loved him the less, even though he never slept through the night until he was five years old.  He had a traumatic birth; and literally from birth was afraid to close his eyes and sleep.  He cried all night, and I cried too, from a mixture of sadness for him and exhaustion for me.

Sometimes it would get too much for me, and I would feel the edges of anger creeping in: why don’t you just go to sleep, damn it?  And then I knew it was time to put him down safely in his crib, shut the door, put in earplugs or the Walkman, and go for a walk in the yard, or around the block, do jumping-jacks, dance and sing, whatever was needed to get back in equilibrium so that I would NOT SHAKE THE BABY.

Sometimes it hangs on such a fine thread.  I’ve seen parents, usually young and inexperienced, bring their pale, limp six week old in to the Emergency Department in the middle of the night.  We just found him like this, Doctor.  He was fine when we put him down.  No, he hasn’t been sick.

Physical exam: Pupils fixed and dilated.  Anterior fontanel bulging.  Otherwise negative, except that the patient is dead.

Postmortem findings consistent with Shaken Baby Syndrome.

Shaken Baby Syndrome doesn’t just only come from shaking.  It happens when the baby is shaken and then thrown down on a surface, usually a bed or crib.  What causes death is the combination of the shaking and the sudden deceleration that causes tearing of blood vessels in the tissues surrounding the brain, which usually results in death.

Why do people shake their baby?  I know exactly why.  That is why I used to put my baby somewhere safe and go outside and walk around the block, or whatever I needed to do to keep myself sane and the baby safe.  It is because the incessant crying of a hard-to-console baby can and will grate on anyone’s nerves.  Some babies have piercing, high-pitched cries that go off like sirens.  And if the caregiver lacks the emotional resources necessary to take a deep breath and step away, the thing can happen in the blink of an eye.

In the blink of an eye, things can go from having a healthy yet frustrating baby, to having a dead baby.  All in the blink of an eye.

Who does this happen to?  I saw a pattern.  The perpetrator was almost always male, usually under 30, high school graduate or less, often not the baby’s biological father.  The motivating factor was “wanting the baby to shut up and stop crying.”  The problem: lack of impulse control.  If only he had taken that deep breath, turned around and walked out that door….but he wanted the baby to stop crying.  Now the baby will never cry again.

And what about the mothers?  My heart broke for them.  Her boyfriend killed her baby.  How will she ever live with herself?  And so often I saw a dreadful conflict: the mothers would lie to the investigators, to try to protect the boyfriend.  Some even claimed to have done it themselves!  It was so sad, so tragic.

To be fair, I did see a few cases in new parents who were “white, educated, middle class”.  A very few.  The vast majority were from economically and educationally underprivileged families, across all ethnic groups.  It is a kind of death that discriminates against the uneducated, the young, the disenfranchised, the controlled.

How do we prevent Shaken Baby Syndrome?  Sure, we can put up “Don’t Shake The Baby” posters everywhere.  But that doesn’t do a thing to solve the social problems that underlie the issue.  We can’t solve the problem of young women getting into relationships with impulsive, controlling men–who by the way are quite as likely to shake and shove the mother around–although she, being full grown, is able to absorb more physical shock than a six week old.

To me, Shaken Baby Syndrome is emblematic of the price we are paying for allowing our girls to grow up in a system of intergenerational abuse that starts at home and continues into serial abusive relationships.  The solution is not a quick and easy one.  It really does take a village to save one child.