Narrating Medicine: The Long Lasting Impact Of Child Abuse

One day when we were in first grade and sitting on a rickety wooden bench under a large oak tree in her backyard, my best friend's mother called her to come inside.

A few minutes later, I heard wailing like an animal being gutted. Squinting my eyes and looking perplexed, I turned to my friend's younger sister who was sitting beside me. She whispered, “She’s just getting beat.” Beat? What’s that, I wondered. She explained. Depending on the severity of their perceived wrongdoings, they were administered one of three levels of physical punishment: a stick, a belt or a big slab of wood. Their parents had moved from Ireland to our small suburb in New Jersey.

The Catholic schools the parents had attended as children in Ireland were very strict and the nuns reportedly beat them until their knuckles bled. Here, as parents in New Jersey, they told their daughters to strip naked and mercilessly receive corporal punishment. (I learned this from her sister, and over the years, from my friend.)

This was not a onetime event. These were repeated, deliberate acts.

The occurrences did not seem to have predictable patterns, so my friend, I'll call her Heather, couldn’t prepare herself for them. And the negative psychological effects for her were deep. Over time, Heather became highly anxious, constantly got in trouble at school, and started a pattern of severe substance misuse that led to even further problems, particularly violations at the hands of men and boys.

Sadly the intentional violence Heather experienced as a child and throughout her adolescence is not an anomaly. Physical abuse is in fact the second most common form of child maltreatment, impacting more than 15 percent of all children living in the U.S. per year.

This despite 40 years of the Child Abuse Prevention and Treatment Act, the first federal child protection legislation to assist in prevention, identification and treatment of child abuse and neglect. This despite another April being another National Child Abuse Prevention Month.

As a trauma psychologist on faculty at Yale, I’m very familiar with the research on and treatment of child abuse. These kinds of repetitive interpersonal damages place a child at greater risk for not only a host of mental health disorders — depression, post-traumatic stress disorder and substance misuse -- but also for further abuse in adulthood. Often referred to as re-victimization, this means that people who have already been hurt can get hurt again and again.

There are several hypotheses on why re-victimization happens. Children come to view themselves as “damaged goods” who don’t deserve or shouldn’t expect better. Abused children aren’t able to recognize safe from unsafe people, and if they do, they don’t have the internal or external resources to protect themselves from danger.

In a recently published study, a team of researchers from the University of Washington found that substance misuse, particularly blackout drinking, predicted incapacitated sexual re-victimization.

And that is exactly what happened to Heather.

The phone calls would always come. “Pick me up,” she’d say, and out I would hobble from bed on weekend mornings during high school and go to a local motel to get my best friend. Hi-Ho, Red Roof Inn, Howard Johnson’s -- the string of cheap motels lined Highway 1 in Central Jersey.

Heather would party all night, binge drinking alcohol and doing any drug she could get her hands on. Her drug of choice was “boat,” a mixture of pot, embalming fluid and animal tranquilizer. But the relief from the child abuse she was suffering at home was only temporary. The hole within her could not be repaired in this way, though I didn’t tell her that at the time because I didn’t know either. At the time I thought I was being a good friend. Pick her up, take her home, never give a word of advice or caution -- just consistency, concern and love.

Heather's binge drinking and drugging often resulted in blackouts. Attempting to anesthetize herself, she would not remember large stretches of time and would be unaware of her surroundings. During one of these blackouts she was allegedly raped by a group of boys who went to a local public high school. From that point until well into her 40s, her drinking and self-loathing got worse.

The pain reverberated throughout her life. She had difficulties finding and sustaining relationships with men and friendships with women. She never graduated college, married or had children. Although an incredibly smart, kind, quick witted individual, she didn’t get a chance to reach her fullest potential. She was unable to let her light shine. Instead, she struggled with the demons of repeated multiple assaults on her soul. She spent many years in psychotherapy trying to rebuild her self-esteem and decrease her depressed mood. And for at least 20 years she has moved in and out of AA.

But the optimal point of intervention for Heather and the thousands of adults who live with the consequences of severe and prolonged childhood abuse and subsequent re-victimization would have been years before. Even though early intervention is what would have been most effective for my friend, it's never too late to seek help and heal from trauma.

It is clear to me, and I hope to you, that we need not just national awareness this April, and every month; we need personal awareness.

Joan M. Cook Ph.D. is an associate professor in the Yale School of Medicine Department of Psychiatry, an Op-Ed Public Voices Fellow and president of the American Psychological Association’s Division of Trauma Psychology.


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