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Apr 28, 2012, 10:02:00 AM
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by Daniel C. Schuman, M.D.
Incest and other forms of abusive physical/sexual behavior by adults toward children have gone under-reported for years. Whether for traditional reasons of children being considered chattel, because of lingering lack of recognition that childhood is a unique and different status from adulthood, or because of societal and adult denial, repeated anecdotal information on child abuse has been discounted. Even now, true prevalence and incidence rates on incest are unreliable.
Recently such bias toward under-reporting of child abuse has begun to be corrected. Nowadays child abuse by physical and/or sexual behavior on the part of adult(s) gets wide attention. There is increasing public recognition that such behavior is much more common than was previously believed. Recent literature has criticized some traditional psychoanalytic theories which tended to ascribe such reports of child incest to children's fantasies. (1) Both medical and legal communities have been criticized for presuming that mothers who report child sexual abuse are either paranoid or vindictive. (2)
In some quarters there is such degree of sensitivity or outrage about possible child abuse that a presumption exists that such abuse has occurred whenever it is alleged. (3) It is possible for a reverse skew to evolve, in which incest or other child sexual abuse can be over-perceived and over-alleged.
Validated cases of over-perception of sexual abuse which were independently examined separate from their psychiatric evaluations have not been reported in the psychiatric literature. Goodwin, Cauthorne, and Rada described a "Cinderella syndrome" of children simulating neglect. (4) Adams, Barone, and Todman suggested that anonymous reports of child abuse may often prove to be false. (5) Meadow illustrated how tragically difficult it may be to detect nonvalid or misleading reports about a child when the historian is a parent, especially one who is over-involved in a child's care. Colm reported case anecdotes of exaggerated reports by children of sexual abuse; such reports were at first believed by the custodial parents but were later doubted after clinical interviews of the parents.(7) Goodwin, Sahd, and Rada reported several cases of false reports assessed by psychiatric criteria alone. (8)
The evolving literature on incest stresses various elements of psychopathology in perpetrators and collaterals, but also makes plain that child abuse occurs in the context of family system functioning.(9) Marital conflict is implied or described in many of these reports and is explicitly invoked as a partial cause of some abuse. (10)
This paper discusses seven cases from the author's practice in which child physical and/or sexual abuse was reported. All of the claims of abuse were ultimately shown to be nonvalid by a two-pronged test: affirmative psychodynamic formulation and subsequent independent justice-system determination. Justice-system determinations were established by "in-house" criteria, i.e., those allegations tried in criminal courts were invalidated by "beyond a reasonable doubt," those tried in Family Court were invalidated by "clear and convincing," and those evaluated by prosecutors were invalidated by "insufficient evidence." Such legal-system processes may not be satisfying taken alone, but they provide essential supplementation to psychiatric evaluation. One case is discussed in detail and others are summarized, with a discussion of possible causative factors following.
Case Presentation
Mr. X was referred for evaluation of his sexual dangerousness toward two of his three minor children, daughters aged four and two years. He was involved in pending Family Court hearings which resulted in a divorce and a decision on visitation and custody of the minor children. Two psychiatrists were appointed by the Court to conduct cooperative but independent evaluations of the family, but with emphasis on Mr. X, the father.
This was the second marriage for each parent. After his first divorce, Mr. X had remained on good terms with his ex-wife, who was a pediatric nurse. She had accurately assessed the mother of one of her patients as needing a lot of emotional and logistical support. Knowing her ex-husband as a "caretaker," she thought that he might want to take the little child's mother under his own wing and she introduced them. During the evaluation Mr. and Mrs: X concurred that their complimentary needs did seem to form the basis for their marriage. However, there were few shared emotional, social, sexual or temperamental affinities.
Mrs. X, 32, was one of two children from her mother's second marriage. Her father had died when she was 10. After having a surgical procedure done for menstrual pain, she became pregnant at age 17; she married one year after her daughter was born to get away from strained family relationships. She said that she lived with her first husband for only a few weeks, and the marriage was terminated by divorce or annulment two years later. She reported several subsequent abusive relationships with men. Mrs. X was very guarded about these early history details.
Her daughter had been born with severe congenital anomalies and underwent multiple hospitalizations and procedures before succumbing at the age of 4%. Both before and after that death, Mrs. X had several crisis contacts and hospitalizations at various psychiatric facilities when she felt in turmoil. She was in chronic pain from rheumatoid arthritis; she wore a foam collar and sometimes a battery-powered device for electrical stimulation of her arms through wires taped on to her arms.
Mrs. X presented herself as stoic, sincere, and genuinely frightened of her husband". And looked like a trapped doe, with darting and plaintive eyes. She evinced an entirely convincing air of wanting desperately to trust an evaluator but also of being frightened of being taken advantage of again. She was pale, wan, and thin; and she radiated an aura of alarm coupled with helplessness. She seemed about to cry or to flee, and could not bring herself to give much early history or information about her psychiatric crises that had resulted from her past bouts of abuse at the hands of men. The whole current situation with her husband had overwhelmed her.
Psychiatric and psychological investigation of Mrs. X included clinical interviewing by both Court-appointed psychiatrists and administration of projective psychological testing obtained privately by her attorney. There was no doubt about the truthfulness of her fear of her husband's violence. She also agreed, after many hours of alliance-building contact, that she often had a tendency to be frightened and intimidated to the point where her own independence of judgment was compromised. She demonstrated this tendency toward her own attorney (a female), toward the author, and sometimes toward the Family Court judge (a male).
Psychological testing showed anxiety, subjective vulnerability, and dependent compliancy to the extent of interfering with her ability to organize unstructured stimuli. There was denial and over-control of anger along with perceptions of external violence. There was no formed paranoid ideation or reality distortions present in the test protocol. Her perceptions were character-syntonic.
Mr. X, 42, was one of 11 children reared in an intact family. His father had been alcoholic for a time but had been sober for many years. There was no family history of psychiatric disease or abuse. A high school graduate, Mr. X joined the Army a year later for three years and was discharged honorably as a sergeant. He married his first wife while in the service. Shortly after his service discharge, he went to work for a technical chemical firm, where he had been employed steadily for 17 years at the time of this evaluation he had risen to the rank of senior supervisor of a production facility. There was no history of alcoholism, drug abuse, authority or legal problems, or any prior psychiatric contact.
With respect to sexual development history, Mr. X reported puberty at around age 12. He remembers his first orgasm as occurring two years later, in heterosexual intercourse. That episode did not fulfill his notions of what it was supposed to be like: he had thought that, "It would be great," but instead he felt scared that his parents would find out or that the girl might get pregnant; he felt awkward and clumsy sexually. He masturbated about twice a year during his teens and no longer masturbates at all. His sexual contacts have been exclusively heterosexual and genital. He has never had any interest in other erogenous areas. He has never had any sexual symptoms, or venereal disease. He has never had any fantasies or actions linking sexual behavior with violence. At the time of the evaluation, he could not remember how long previously he had last had intercourse; it was at least many months. He said that he was so preoccupied with his domestic difficulties and/or with his work that he did not miss sex too much. He had no findings of vegetative depression on mental status examination. Mr. X and his first wife both reported that their marriage had cooled over the years and that they had grown apart for reasons neither of them understood. They had parted amicably after 16 years and remained in frequent, cooperative contact around issues of childrearing. At the time that Mr. X's ex-wife had introduced him to his second wife, Mr.'X had three teenage children from his first marriage. Two were in the custody of his ex-wife, but the oldest had died shortly before the allegations of abuse toward his "second family" were brought by his second wife. That child bad had intractable temporal lobe epilepsy for years and died during an experimental neurosurgical diagnostic procedure.
Detailed psychiatric and psychological examination of Mr. X included many hours of clinical psychiatric interviews by both psychiatrists, computer-scored MMPI, and independent projective psychological testing. Findings from this evaluation revealed an obsessive character structure with strong passive trends and defensive use of reaction formation to deal with grief and his own unsatisfied dependency needs. He was a repetitive "caretaker" and a "workaholic," with repressed anger and libido. Serial observations of Mr. X over many months of evaluation and legal proceedings showed him to continue to evince beneficence rather than resentment. His own attorney was surprised at how little anger he displayed. In sum, all clinical and test findings on Mr. X were consistent with each other but were at odds with his second wife's genuine perceptions.
The X's marriage was stormy, with many arguments and mutual accusations of aberration: Mr,. X Perceived her husband as violent and threatening, and Mr. X saw her as devious, needy and distorting in her reports. At the time of the Court-ordered evaluation and marital separation there were three children, two girls aged four and two, and a boy aged one. Mrs. X had named the two-year old, her third daughter, after her deceased first daughter. At the time of the separation, all three children lived with her in the marital home from which Mr. X had been involuntarily vacated by Court order because of her reports of his abuse and violence.
The report of child abuse began when Mrs. X told her attorney that several months earlier, the two older children (the girls) had cried when their father bathed them and that the girls had said that their father had hurt their "bummies." Later, it was reported that Mrs. X's mother, who lived downstairs and who was a frequent visitor in their apartment, had witnessed "fresh evidence" of father's abuse of the children. Mrs. X's attorney referred her and the children to a major Boston psychiatric teaching center with a child-abuse unit, where they were seen in emergency evaluation.
When first seen, mother and children were terrified. Mother reported details of crazed and violent behavior on the part of her husband. She said that he had on one occasion barricaded the house and had placed vehicle traps like tank traps in the driveway to ward off "intruders." She said that he had threatened her with a loaded rifle which he had slammed down on the kitchen table one night after rousing the entire family to harangue them about outside dangers. She said that he had brandished a knife at her, leaving her convinced that he might soon attack her with it. Mother reported father's having beaten her and said that her older daughter had told her that daddy had manually penetrated her vagina and had hurt her "bum."
The four-year old daughter was seen individually in Clinical psychiatric interview and communicated graphically both with play techniques and in words that her father had beaten her and had penetrated her vaginally and anally by hand she repeated that her father had beaten her two-year old sister. The two-year old girl merely sucked her thumb, hugged her blanket, showed immature and inappropriate emotions, and was otherwise uncommunicative.
Based on the initial examination, the center recommended psychiatric evaluation of the father, no paternal visits with the children, "consideration" of criminal action against the father, and offered a diagnosis on the father of either post-traumatic stress syndrome or psychosis of undetermined etiology. After discussion among several of that institution's psychiatric staff, a second evaluating psychiatrist stated that she herself would be in physical danger from father if she were to interview him alone. The team and the child psychiatry department were convinced of the veracity of the child abuse, and stated that they never had had a four-year old misreport abuse; they said, "Children don't lie."
Mr. X's attorney pressed the Family Court for further evaluation, which was ordered to be done by the original evaluating institution and by an independent psychiatrist in concert. In the course of that extended, multifaceted contact additional data emerged including the psychological testing reported above.
Mother had also taken the four-year old girl to another academic medical center for pediatric neurological evaluation of reported "absence episodes;" the neurological evaluator was blind to the domestic difficulties and instituted antisiezure medications although his report was skeptical and guarded. Mother had also taken the girls to a psychological counselor but had never told the counselor about the psychiatric evaluations or the neurological evaluation and had obscured knowledge of the counseling to the psychiatrists until she was directly asked about it late in the evaluation. Expanded, supportive evaluation sessions with the children revealed the four-year old girl to have a "canned" story about the alleged abuse which had no affective depth (in contrast to her initial terror) and which was belied by her subsequent warm, easy, spontaneous contact with father during visitations that ultimately were allowed.
Ultimately mother reported that she herself had not believed that the children had suffered sexual abuse. She then reported the inciting incident differently: she Said that what had really happened was that she had objected to father's roughness or rough-housing the children during a bath several times. Mother then reported that her attorney had intimidated her into reporting the incident as abuse and said that she had gone over the story many times with her daughters.
Until the Family Court re-instituted paternal visits, the three young children had not seen their father for almost 1.5 years. Following a period of gradually lengthened paternal visits, first supervised and then "solo", Mr. X was given sole legal custody of all three minor children. Followup nine months later revealed the children to have no psychiatric symptoms.
Case Results Summary
Six additional cases along with the X family (case 1) are summarized in Table A. (NOTE: table not shown here)
All of the cases presented involve contested, acrimonious domestic litigation. Some of the marital families were in the process of splitting apart via separation and/or divorce; some had been reconstituted through subsequent remarriage. In five of the seven cases, custody and/or visitation was an express element of dispute before the allegations of child abuse occurred, but in the other two cases the alleged offence seemed either incidental to the marital litigation (case 2) or a distraction from it (case 6). In six of the cases the alleged victims were female, while in one the alleged victim was male. All of the accused offenders were male.
In all cases, the initial reports were said to have come from the alleged victims. In one of the seven cases, the alleged victim maintained an active role in pursuing the case (she was the oldest of the alleged victims); in the other six cases, the reporting children took a back seat to adults who pursued the abuse allegations in their behalf. The alleged victims ranged in age from two to 13 years at the time of the alleged offenses.
In all cases, the initial reports were said to have come from the alleged victims. In one of the seven cases, the alleged victim maintained an active role in pursuing the case (she was the oldest of the alleged victims); in the other six cases, the reporting children took a back seat to adults who pursued the abuse allegations in their behalf. The alleged victims ranged in age from two to 13 years at the time of the alleged offenses.
The nature of the offenses had a wide range. They included burning of a victim on a radiator, physical beating, various sexual caresses, erotic kissing, manual vaginal and anal penetration, and vaginal intercourse. In one case there were innuendos of links to pornographic materials.
The familiar hallmark of abuse is equivocal in this series. It has been imputed that males with good sexual adjustment do not commit sexual misconduct; the implication is that inadequate male sexual adjustment may be one indicator of possible perpetration of abuse. In this cohort one of the seven accused males had chronically poor or inadequate sexual adjustment; three others had notably diminished libido or equivocal adjustment; two of the remaining three men had transiently impaired libido during the stress of the accusations.
In case 2, the mother seems to have been distreesed at parenting difficulties she herself had with her daughter and perplexedly asked many people what kind of parenting behavior was or would be appropriate on the part of her husband. She seemed nonplussed at his desires to be involved in parenting his daughter; she appeared to feel aimless and unidentified without the social mission of motherhood. After her initial report of her husband's over-involvement with their daughter, a social agency intervened and pressed an investigation of the father beyond what the mother said that she had intended. She said that she had never thought that he had molested their daughter. Later, she passed on a "neighborhood report" that her husband had "fondled" a "three-year old named Greta." The social service agency took that report seriously, but subsequent investigation showed the "three-year old" to be a dog.
In case 3, the alleged victim's biologic father had told the mother at the time of their divorce that he "would do anything" to obtain custody of their daughter, and for years he had told their daughter that he wanted her to live with him. The daughter was involved in many disciplinary disputes with her mother, especially after the mother's remarriage, and after one of them the daughter swallowed an overdose of aspirin. When she was admitted for psychiatric evaluation, she reported the alleged offenses against her step-father (who was a moralistic, obsessive, "straight arrow.") No gynecologic evaluation was obtained despite the request of the girl's (custodial) mother. After the mother agreed to a change of custody, the girl recanted all of her accusations, saying that she had intended them as a means of changing custody for herself.
The mother in case 4 felt caught between her ex-husband (who wanted desperately to maintain a parenting relationship with their son) and her current husband (who was sterile and who revealed a compelling need to be a parent when he was evaluated). Her ex-husband admitted having a collection of "soft-core pornography" which was readily available to their son when he was left alone during paternal visits. When the boy "acted strangely" after visits with the father, mother complained to her attorney at the behest of her husband. A rape crisis evaluator reported a conclusion that homosexual fondling had occurred during visits, but the source of that information was never clarified and the boy never spoke of such activity. Two psychiatric evaluations of the adults and the boy could detect no sexual misbehaviors, though father's questionable judgment about his erotic material and step-father's compulsions about parenting combined to create an atmosphere of charged sexuality surrounding the boy.
In case 5, the mother's third attorney was vociferous in demanding vindication for her and for her two daughters. A former nun, she had married a divorced man with a daughter from his first marriage. He was a withdrawn, guarded, evasive fellow from whom it was very hard to get information about this life. After a visit with father, the youngest girl was found with a burn on her wrist. How that occurred was never made clear, but one version said that her elder half-sister had pressed her arm to a hot radiator while father was out of the house. Subsequently the half-sister was sent out-of-state to live with her mother, but the mother of the two alleged victims continued to elaborate further reports of abuse. She accused her estranged husband of transvestism during visits and of harsh discipline that amounted to battery. She placed stringent limitations on what psychiatric evaluation she would permit, but when she finally assented, her own frank thought disorder was revealed. Father was considered to have a stable obsessive/schizoid personality disorder with no acting-out proclivities and generally diminished libido. Eventually mother's accusations became so elaborate as to be insupportable.
In case 6: a six year old girl reported that she had been vaginally penetrated in her house by a teenage family friend who had often been her babysitter; the alleged offense occurred during a picnic attended by both families. The accusations were zealously pressed by the victim's father, who was involved in a stormy second marriage that had many heavily sexual overtones (reportedly frank pornographic video cassettes were left available to the children and the adults' sex life was a matter of inter-family discussion). The father's reconstituted family banded together in the cause of the prosecution. Father's son by his first marriage had just come to live with them, and the father's second marriage had shown signs of substantial deterioration just prior to the allegations of daughter's abuse. No medical examination was obtained despite the fact that the alleged victim's father was a physician. Psychiatric evaluation showed the alleged offender to be a passive, slightly withdrawn youngster with delayed sexual maturation and a low level of libido. When further evaluation was pursued, the victim's father refused to cooperate and withdrew all charges.
In case 7: during a visitation dispute mother reported her "concerns" about father's conduct with their daughter during visitations. She had remarried and wanted to move out-of-state, which the girl's father objected to. Mother then sought to limit visits because of father's alleged sexual misconduct.
Mother reported to Family Court that months earlier her daughter had told her of father's Sex acts with her. Mother had not discussed the matter again with the girl until the visitation dispute arose. The only medical examination ever obtained by mother showed no physical penetration or soft tissue injuries to her daughter. The girl had never complained of any pain and mother had noticed nothing amiss while bathing her shortly after the alleged rape had been said to occur.
The Family Court judge reported the case to the state Social Service Department and to the District Attorney's office, but prosecution was not pressed until father demanded a trial to vindicate himself in view of continuing visitation problems. The Social Service evaluation included psychological testing which was performed with the presumption that the abuse had occurred; the girl's responses which showed unexpectedly little sexual anxiety were explained as her being defensive. The evaluation results were based partly on drawings which mother had made for her daughter and which were then interpreted as manifesting sexual anxiety. Mother's history of being sexually abused as a teenager and her own sexual anxieties were apparently not known or inquired into at that time. Father was never evaluated; his pursuit of evaluation was characterized as being defensively manipulative. In the Course of months of trial preparation, father and daughter were quarantined from each other and the daughter was prepared in detail for testimony.
Ultimately the girl testified some three years after the initial incident was alleged to have occurred. She graphically described several occasions of oral and vaginal intercourse to orgasm, some of which she said occurred a times when she had not even been with her father. Her testimony was generally perceived as sincere, including her report of having behaved in a "weird" fashion after the alleged abuse. Asked how she knew that she had acted "weird," she said that her mother had told her so. At the jury "waived trial, father "was found not guilty of all charges.
In all of the cases, a final judicial or prosecutorial determination of non-misconduct was made. In three of the cases, judicial determination was assisted by formal social service agency input. Three cases were handled by Family Court alone, one case was processed by concurrent Jurisdiction by Family and criminal Court (in which the criminal charges were prosecuted to a not guilty verdict), two cases were handled by both Family Court and District Attorney's office (no prosecution was made in either case, and one case was prosecuted in criminal court alone (charges were dismissed).
Discussion
An earlier publication (11) has discussed the nature and etiology of psychiatric regression in adults during domestic relations litigation. Such regression in adults has instinctual, defensive, and behavioral components. Each component is unique in its degree of regression in an individual caught in a specific domestic tangle, and the whole regressive syndrome was seen as potential rather than as inevitable.
The hypothesis was offered that a primary dynamic etiology was the loss of a "parenting fantasy" which had served to restitute in psychic function or early developmental losses. This hypothesis serves to account for abrupt appearance of some of the " out of character," regressed behavior which is often seen in otherwise intact people who become caught up in contested domestic relations litigation.
One aspect of potential regressed behavior on the part of adults is an increased focus on sexuality, as well as a maladaptive amalgamation of bitterness, vindictive anger, or loss with sex. These emotional forces accrue great power to generate aberrant sexual actions by adults. Marital breakdown as one form of family disorganization, and the social isolation that often accompanies "involuntary single parenthood," are additional causative factors in adult sexual actions that can be abusive to children.
All of the above factors bear on situations in which sexual aberrations can or do occur. But sometimes the actions have not occurred, and such factors also bear on parents' or step-parents' nonvalid perceptions of abuse as a regressive phenomenon in its own right. Step-parents are drawn into the vortex too, and become active participants as is demonstrated in three of the cases discussed above. Step-parents' nonsexual fantasies are central to the operation of "reconstituted" families, as are their reactions or sensitivities to issues of loss, blame, failure, control; and territoriality.
It is equally noteworthy that children's reactions to stresses of marital breakdown can contribute to nonvalid reports of sexual abuse such as the cases reported here. In children, family turmoil is well known to elicit regression of analogous variety: in affective instincts, in defensive adaptations, and in behavior. Children have no "parenting fantasy" to lose, but marital breakdown presents them with unavoidable real and intangible losses that must be of even greater magnitude than those their parents sustain.
For children of divorce, in addition to the primary experience of tangible emotional loss, they are confronted with actual intrapsychic conflicts beyond their realistic capacity to resolve. "Actual" conflicts, whether tangible or not, are often presented to children for their opinions or choices; they may involve issues of custody, visitation, or property/financial matters. Intangible conflicts of divided loyalty, children's sense of failure or guilt about the failure of parental marriage or happiness, or inexpressible sadness or anger are even thornier issues.
The doctrines of "expressed preference of the child" in domestic civil litigation and "right to testify" in criminal and/or child abuse litigation have generated increased resort to such use of children as witnesses in litigation, irrespective of a child's more basic right to be cared for in supportive fashion by all of the adults around him, including the legal system.
In many cases, a child. witness's competency to testify may well be impaired by the existence of cognitive/intellectual or emotional conflicts. (12) This is especially true in cases of criminal prosecution or alleged intra-family incest when the child victim testifies against an alleged parental or close-relation perpetrator. Testimonial impairment in such cases goes far beyond the truism that no witness is fully accurate.
Elaborate "preparation" of a potential child witness (13), including rehearsal of testimony and role-playing does nothing to resolve or mitigate such conflict in the child's mind. In some cases, a child has been taken into an unoccupied courtroom and has been encouraged to recite anticipated testimony while sitting on the trial judge's bench.
Potential causes for regression in a child's developmental level of emotional instinct during domestic breakdown involve, among other possibilities, the following:
References
. Massonn, J.: The assault on truth: Freud's Suppression of the Seduction Theory. Farrar, Strauss & Giroux, 1984
2. Armstrong, L.: Daddy Dearest. Connecticut, 53-127, January, 1984
3. Shipp, E.R.: The Jeopardy of Children on the Stand. N.Y. Times, E8, September 23, 1984
4. Goodwin, J., Cauthorne, C.G., Rada, R.T.: Cinderella Syndrome: Children who Simulate Neglect. Am. J. Psychiat. 137:1223-1225, 1980
5. Adams, W., Barone, N., Todman, P.s The Dilemma of Anonymous Reporting in Child Protective Services. Child Welfare 61:3-14, 1982
6.Meadow,R. Munchausen Syndrome by Proxy. Lancet 2(8033):343-345, 1977
7. Colm, H.: Children's Sexual Preoccupation as a Reaction to Difficult Family Relationships and the Parents' Anxieties about Sex: Four Cases. J. Ch. Psychiat. 2:205-220; 1963
8. Goodwin, J., Sahd, D., Rada, R.: Incest Hoax: Fake Accusations, False Denials. Bull. Am. Acad. Psych. and the Law V:269-276, 1978
9. Garland, J.A.: Group Treatment of Sexual Abuse. In A Report to the Commissioner: Sexual Abuse Treatment in Brockton, Mass. Dept. of Social Services, Nov. 15, 1983
10. Lansky, S.B., and Erikson, H.M.: Prevention of Child Murder. J. Amer. Acad. Child Psychiat. 13:691-696, 1974
11. Schuman, D.C.: Psychodynamics of Custody Loss. Chapter 4 in Children of Separation and Divorce: Management and Treatment. Abt., L. and Stuart, L, eds. New York, Van Nostrand, 1981
12. Schuman, D.C.: The Unreliability of Children's Expression of Preference in Domestic Relations Litigation: A Psychiatric approach. Massachusetts Law Rev. 63:1, 14-19, March, 1984
13. Bauer, H.: Preparation of the Sexually Abused Child for Court Testimony. Bull. Amer. Acad. Psychiat. and the Law 11:287-291,. 1983
14. Bergen, M.E.: The Effect of Severe Trauma on a Four-Year Old Child. Psychoanal. Study of the Child 13: 407-429, 1958
15. Schuman, D.C.: Psychodynamics of Custody Loss. In Children of Separation and Divorce: Management and Treatment. Abt., L. and Stuart, L, eds. New York, Van Nostrand, 1981. P. 66
Incest and other forms of abusive physical/sexual behavior by adults toward children have gone under-reported for years. Whether for traditional reasons of children being considered chattel, because of lingering lack of recognition that childhood is a unique and different status from adulthood, or because of societal and adult denial, repeated anecdotal information on child abuse has been discounted. Even now, true prevalence and incidence rates on incest are unreliable.
Recently such bias toward under-reporting of child abuse has begun to be corrected. Nowadays child abuse by physical and/or sexual behavior on the part of adult(s) gets wide attention. There is increasing public recognition that such behavior is much more common than was previously believed. Recent literature has criticized some traditional psychoanalytic theories which tended to ascribe such reports of child incest to children's fantasies. (1) Both medical and legal communities have been criticized for presuming that mothers who report child sexual abuse are either paranoid or vindictive. (2)
In some quarters there is such degree of sensitivity or outrage about possible child abuse that a presumption exists that such abuse has occurred whenever it is alleged. (3) It is possible for a reverse skew to evolve, in which incest or other child sexual abuse can be over-perceived and over-alleged.
Validated cases of over-perception of sexual abuse which were independently examined separate from their psychiatric evaluations have not been reported in the psychiatric literature. Goodwin, Cauthorne, and Rada described a "Cinderella syndrome" of children simulating neglect. (4) Adams, Barone, and Todman suggested that anonymous reports of child abuse may often prove to be false. (5) Meadow illustrated how tragically difficult it may be to detect nonvalid or misleading reports about a child when the historian is a parent, especially one who is over-involved in a child's care. Colm reported case anecdotes of exaggerated reports by children of sexual abuse; such reports were at first believed by the custodial parents but were later doubted after clinical interviews of the parents.(7) Goodwin, Sahd, and Rada reported several cases of false reports assessed by psychiatric criteria alone. (8)
The evolving literature on incest stresses various elements of psychopathology in perpetrators and collaterals, but also makes plain that child abuse occurs in the context of family system functioning.(9) Marital conflict is implied or described in many of these reports and is explicitly invoked as a partial cause of some abuse. (10)
This paper discusses seven cases from the author's practice in which child physical and/or sexual abuse was reported. All of the claims of abuse were ultimately shown to be nonvalid by a two-pronged test: affirmative psychodynamic formulation and subsequent independent justice-system determination. Justice-system determinations were established by "in-house" criteria, i.e., those allegations tried in criminal courts were invalidated by "beyond a reasonable doubt," those tried in Family Court were invalidated by "clear and convincing," and those evaluated by prosecutors were invalidated by "insufficient evidence." Such legal-system processes may not be satisfying taken alone, but they provide essential supplementation to psychiatric evaluation. One case is discussed in detail and others are summarized, with a discussion of possible causative factors following.
Case Presentation
Mr. X was referred for evaluation of his sexual dangerousness toward two of his three minor children, daughters aged four and two years. He was involved in pending Family Court hearings which resulted in a divorce and a decision on visitation and custody of the minor children. Two psychiatrists were appointed by the Court to conduct cooperative but independent evaluations of the family, but with emphasis on Mr. X, the father.
This was the second marriage for each parent. After his first divorce, Mr. X had remained on good terms with his ex-wife, who was a pediatric nurse. She had accurately assessed the mother of one of her patients as needing a lot of emotional and logistical support. Knowing her ex-husband as a "caretaker," she thought that he might want to take the little child's mother under his own wing and she introduced them. During the evaluation Mr. and Mrs: X concurred that their complimentary needs did seem to form the basis for their marriage. However, there were few shared emotional, social, sexual or temperamental affinities.
Mrs. X, 32, was one of two children from her mother's second marriage. Her father had died when she was 10. After having a surgical procedure done for menstrual pain, she became pregnant at age 17; she married one year after her daughter was born to get away from strained family relationships. She said that she lived with her first husband for only a few weeks, and the marriage was terminated by divorce or annulment two years later. She reported several subsequent abusive relationships with men. Mrs. X was very guarded about these early history details.
Her daughter had been born with severe congenital anomalies and underwent multiple hospitalizations and procedures before succumbing at the age of 4%. Both before and after that death, Mrs. X had several crisis contacts and hospitalizations at various psychiatric facilities when she felt in turmoil. She was in chronic pain from rheumatoid arthritis; she wore a foam collar and sometimes a battery-powered device for electrical stimulation of her arms through wires taped on to her arms.
Mrs. X presented herself as stoic, sincere, and genuinely frightened of her husband". And looked like a trapped doe, with darting and plaintive eyes. She evinced an entirely convincing air of wanting desperately to trust an evaluator but also of being frightened of being taken advantage of again. She was pale, wan, and thin; and she radiated an aura of alarm coupled with helplessness. She seemed about to cry or to flee, and could not bring herself to give much early history or information about her psychiatric crises that had resulted from her past bouts of abuse at the hands of men. The whole current situation with her husband had overwhelmed her.
Psychiatric and psychological investigation of Mrs. X included clinical interviewing by both Court-appointed psychiatrists and administration of projective psychological testing obtained privately by her attorney. There was no doubt about the truthfulness of her fear of her husband's violence. She also agreed, after many hours of alliance-building contact, that she often had a tendency to be frightened and intimidated to the point where her own independence of judgment was compromised. She demonstrated this tendency toward her own attorney (a female), toward the author, and sometimes toward the Family Court judge (a male).
Psychological testing showed anxiety, subjective vulnerability, and dependent compliancy to the extent of interfering with her ability to organize unstructured stimuli. There was denial and over-control of anger along with perceptions of external violence. There was no formed paranoid ideation or reality distortions present in the test protocol. Her perceptions were character-syntonic.
Mr. X, 42, was one of 11 children reared in an intact family. His father had been alcoholic for a time but had been sober for many years. There was no family history of psychiatric disease or abuse. A high school graduate, Mr. X joined the Army a year later for three years and was discharged honorably as a sergeant. He married his first wife while in the service. Shortly after his service discharge, he went to work for a technical chemical firm, where he had been employed steadily for 17 years at the time of this evaluation he had risen to the rank of senior supervisor of a production facility. There was no history of alcoholism, drug abuse, authority or legal problems, or any prior psychiatric contact.
With respect to sexual development history, Mr. X reported puberty at around age 12. He remembers his first orgasm as occurring two years later, in heterosexual intercourse. That episode did not fulfill his notions of what it was supposed to be like: he had thought that, "It would be great," but instead he felt scared that his parents would find out or that the girl might get pregnant; he felt awkward and clumsy sexually. He masturbated about twice a year during his teens and no longer masturbates at all. His sexual contacts have been exclusively heterosexual and genital. He has never had any interest in other erogenous areas. He has never had any sexual symptoms, or venereal disease. He has never had any fantasies or actions linking sexual behavior with violence. At the time of the evaluation, he could not remember how long previously he had last had intercourse; it was at least many months. He said that he was so preoccupied with his domestic difficulties and/or with his work that he did not miss sex too much. He had no findings of vegetative depression on mental status examination. Mr. X and his first wife both reported that their marriage had cooled over the years and that they had grown apart for reasons neither of them understood. They had parted amicably after 16 years and remained in frequent, cooperative contact around issues of childrearing. At the time that Mr. X's ex-wife had introduced him to his second wife, Mr.'X had three teenage children from his first marriage. Two were in the custody of his ex-wife, but the oldest had died shortly before the allegations of abuse toward his "second family" were brought by his second wife. That child bad had intractable temporal lobe epilepsy for years and died during an experimental neurosurgical diagnostic procedure.
Detailed psychiatric and psychological examination of Mr. X included many hours of clinical psychiatric interviews by both psychiatrists, computer-scored MMPI, and independent projective psychological testing. Findings from this evaluation revealed an obsessive character structure with strong passive trends and defensive use of reaction formation to deal with grief and his own unsatisfied dependency needs. He was a repetitive "caretaker" and a "workaholic," with repressed anger and libido. Serial observations of Mr. X over many months of evaluation and legal proceedings showed him to continue to evince beneficence rather than resentment. His own attorney was surprised at how little anger he displayed. In sum, all clinical and test findings on Mr. X were consistent with each other but were at odds with his second wife's genuine perceptions.
The X's marriage was stormy, with many arguments and mutual accusations of aberration: Mr,. X Perceived her husband as violent and threatening, and Mr. X saw her as devious, needy and distorting in her reports. At the time of the Court-ordered evaluation and marital separation there were three children, two girls aged four and two, and a boy aged one. Mrs. X had named the two-year old, her third daughter, after her deceased first daughter. At the time of the separation, all three children lived with her in the marital home from which Mr. X had been involuntarily vacated by Court order because of her reports of his abuse and violence.
The report of child abuse began when Mrs. X told her attorney that several months earlier, the two older children (the girls) had cried when their father bathed them and that the girls had said that their father had hurt their "bummies." Later, it was reported that Mrs. X's mother, who lived downstairs and who was a frequent visitor in their apartment, had witnessed "fresh evidence" of father's abuse of the children. Mrs. X's attorney referred her and the children to a major Boston psychiatric teaching center with a child-abuse unit, where they were seen in emergency evaluation.
When first seen, mother and children were terrified. Mother reported details of crazed and violent behavior on the part of her husband. She said that he had on one occasion barricaded the house and had placed vehicle traps like tank traps in the driveway to ward off "intruders." She said that he had threatened her with a loaded rifle which he had slammed down on the kitchen table one night after rousing the entire family to harangue them about outside dangers. She said that he had brandished a knife at her, leaving her convinced that he might soon attack her with it. Mother reported father's having beaten her and said that her older daughter had told her that daddy had manually penetrated her vagina and had hurt her "bum."
The four-year old daughter was seen individually in Clinical psychiatric interview and communicated graphically both with play techniques and in words that her father had beaten her and had penetrated her vaginally and anally by hand she repeated that her father had beaten her two-year old sister. The two-year old girl merely sucked her thumb, hugged her blanket, showed immature and inappropriate emotions, and was otherwise uncommunicative.
Based on the initial examination, the center recommended psychiatric evaluation of the father, no paternal visits with the children, "consideration" of criminal action against the father, and offered a diagnosis on the father of either post-traumatic stress syndrome or psychosis of undetermined etiology. After discussion among several of that institution's psychiatric staff, a second evaluating psychiatrist stated that she herself would be in physical danger from father if she were to interview him alone. The team and the child psychiatry department were convinced of the veracity of the child abuse, and stated that they never had had a four-year old misreport abuse; they said, "Children don't lie."
Mr. X's attorney pressed the Family Court for further evaluation, which was ordered to be done by the original evaluating institution and by an independent psychiatrist in concert. In the course of that extended, multifaceted contact additional data emerged including the psychological testing reported above.
Mother had also taken the four-year old girl to another academic medical center for pediatric neurological evaluation of reported "absence episodes;" the neurological evaluator was blind to the domestic difficulties and instituted antisiezure medications although his report was skeptical and guarded. Mother had also taken the girls to a psychological counselor but had never told the counselor about the psychiatric evaluations or the neurological evaluation and had obscured knowledge of the counseling to the psychiatrists until she was directly asked about it late in the evaluation. Expanded, supportive evaluation sessions with the children revealed the four-year old girl to have a "canned" story about the alleged abuse which had no affective depth (in contrast to her initial terror) and which was belied by her subsequent warm, easy, spontaneous contact with father during visitations that ultimately were allowed.
Ultimately mother reported that she herself had not believed that the children had suffered sexual abuse. She then reported the inciting incident differently: she Said that what had really happened was that she had objected to father's roughness or rough-housing the children during a bath several times. Mother then reported that her attorney had intimidated her into reporting the incident as abuse and said that she had gone over the story many times with her daughters.
Until the Family Court re-instituted paternal visits, the three young children had not seen their father for almost 1.5 years. Following a period of gradually lengthened paternal visits, first supervised and then "solo", Mr. X was given sole legal custody of all three minor children. Followup nine months later revealed the children to have no psychiatric symptoms.
Case Results Summary
Six additional cases along with the X family (case 1) are summarized in Table A. (NOTE: table not shown here)
All of the cases presented involve contested, acrimonious domestic litigation. Some of the marital families were in the process of splitting apart via separation and/or divorce; some had been reconstituted through subsequent remarriage. In five of the seven cases, custody and/or visitation was an express element of dispute before the allegations of child abuse occurred, but in the other two cases the alleged offence seemed either incidental to the marital litigation (case 2) or a distraction from it (case 6). In six of the cases the alleged victims were female, while in one the alleged victim was male. All of the accused offenders were male.
In all cases, the initial reports were said to have come from the alleged victims. In one of the seven cases, the alleged victim maintained an active role in pursuing the case (she was the oldest of the alleged victims); in the other six cases, the reporting children took a back seat to adults who pursued the abuse allegations in their behalf. The alleged victims ranged in age from two to 13 years at the time of the alleged offenses.
In all cases, the initial reports were said to have come from the alleged victims. In one of the seven cases, the alleged victim maintained an active role in pursuing the case (she was the oldest of the alleged victims); in the other six cases, the reporting children took a back seat to adults who pursued the abuse allegations in their behalf. The alleged victims ranged in age from two to 13 years at the time of the alleged offenses.
The nature of the offenses had a wide range. They included burning of a victim on a radiator, physical beating, various sexual caresses, erotic kissing, manual vaginal and anal penetration, and vaginal intercourse. In one case there were innuendos of links to pornographic materials.
The familiar hallmark of abuse is equivocal in this series. It has been imputed that males with good sexual adjustment do not commit sexual misconduct; the implication is that inadequate male sexual adjustment may be one indicator of possible perpetration of abuse. In this cohort one of the seven accused males had chronically poor or inadequate sexual adjustment; three others had notably diminished libido or equivocal adjustment; two of the remaining three men had transiently impaired libido during the stress of the accusations.
In case 2, the mother seems to have been distreesed at parenting difficulties she herself had with her daughter and perplexedly asked many people what kind of parenting behavior was or would be appropriate on the part of her husband. She seemed nonplussed at his desires to be involved in parenting his daughter; she appeared to feel aimless and unidentified without the social mission of motherhood. After her initial report of her husband's over-involvement with their daughter, a social agency intervened and pressed an investigation of the father beyond what the mother said that she had intended. She said that she had never thought that he had molested their daughter. Later, she passed on a "neighborhood report" that her husband had "fondled" a "three-year old named Greta." The social service agency took that report seriously, but subsequent investigation showed the "three-year old" to be a dog.
In case 3, the alleged victim's biologic father had told the mother at the time of their divorce that he "would do anything" to obtain custody of their daughter, and for years he had told their daughter that he wanted her to live with him. The daughter was involved in many disciplinary disputes with her mother, especially after the mother's remarriage, and after one of them the daughter swallowed an overdose of aspirin. When she was admitted for psychiatric evaluation, she reported the alleged offenses against her step-father (who was a moralistic, obsessive, "straight arrow.") No gynecologic evaluation was obtained despite the request of the girl's (custodial) mother. After the mother agreed to a change of custody, the girl recanted all of her accusations, saying that she had intended them as a means of changing custody for herself.
The mother in case 4 felt caught between her ex-husband (who wanted desperately to maintain a parenting relationship with their son) and her current husband (who was sterile and who revealed a compelling need to be a parent when he was evaluated). Her ex-husband admitted having a collection of "soft-core pornography" which was readily available to their son when he was left alone during paternal visits. When the boy "acted strangely" after visits with the father, mother complained to her attorney at the behest of her husband. A rape crisis evaluator reported a conclusion that homosexual fondling had occurred during visits, but the source of that information was never clarified and the boy never spoke of such activity. Two psychiatric evaluations of the adults and the boy could detect no sexual misbehaviors, though father's questionable judgment about his erotic material and step-father's compulsions about parenting combined to create an atmosphere of charged sexuality surrounding the boy.
In case 5, the mother's third attorney was vociferous in demanding vindication for her and for her two daughters. A former nun, she had married a divorced man with a daughter from his first marriage. He was a withdrawn, guarded, evasive fellow from whom it was very hard to get information about this life. After a visit with father, the youngest girl was found with a burn on her wrist. How that occurred was never made clear, but one version said that her elder half-sister had pressed her arm to a hot radiator while father was out of the house. Subsequently the half-sister was sent out-of-state to live with her mother, but the mother of the two alleged victims continued to elaborate further reports of abuse. She accused her estranged husband of transvestism during visits and of harsh discipline that amounted to battery. She placed stringent limitations on what psychiatric evaluation she would permit, but when she finally assented, her own frank thought disorder was revealed. Father was considered to have a stable obsessive/schizoid personality disorder with no acting-out proclivities and generally diminished libido. Eventually mother's accusations became so elaborate as to be insupportable.
In case 6: a six year old girl reported that she had been vaginally penetrated in her house by a teenage family friend who had often been her babysitter; the alleged offense occurred during a picnic attended by both families. The accusations were zealously pressed by the victim's father, who was involved in a stormy second marriage that had many heavily sexual overtones (reportedly frank pornographic video cassettes were left available to the children and the adults' sex life was a matter of inter-family discussion). The father's reconstituted family banded together in the cause of the prosecution. Father's son by his first marriage had just come to live with them, and the father's second marriage had shown signs of substantial deterioration just prior to the allegations of daughter's abuse. No medical examination was obtained despite the fact that the alleged victim's father was a physician. Psychiatric evaluation showed the alleged offender to be a passive, slightly withdrawn youngster with delayed sexual maturation and a low level of libido. When further evaluation was pursued, the victim's father refused to cooperate and withdrew all charges.
In case 7: during a visitation dispute mother reported her "concerns" about father's conduct with their daughter during visitations. She had remarried and wanted to move out-of-state, which the girl's father objected to. Mother then sought to limit visits because of father's alleged sexual misconduct.
Mother reported to Family Court that months earlier her daughter had told her of father's Sex acts with her. Mother had not discussed the matter again with the girl until the visitation dispute arose. The only medical examination ever obtained by mother showed no physical penetration or soft tissue injuries to her daughter. The girl had never complained of any pain and mother had noticed nothing amiss while bathing her shortly after the alleged rape had been said to occur.
The Family Court judge reported the case to the state Social Service Department and to the District Attorney's office, but prosecution was not pressed until father demanded a trial to vindicate himself in view of continuing visitation problems. The Social Service evaluation included psychological testing which was performed with the presumption that the abuse had occurred; the girl's responses which showed unexpectedly little sexual anxiety were explained as her being defensive. The evaluation results were based partly on drawings which mother had made for her daughter and which were then interpreted as manifesting sexual anxiety. Mother's history of being sexually abused as a teenager and her own sexual anxieties were apparently not known or inquired into at that time. Father was never evaluated; his pursuit of evaluation was characterized as being defensively manipulative. In the Course of months of trial preparation, father and daughter were quarantined from each other and the daughter was prepared in detail for testimony.
Ultimately the girl testified some three years after the initial incident was alleged to have occurred. She graphically described several occasions of oral and vaginal intercourse to orgasm, some of which she said occurred a times when she had not even been with her father. Her testimony was generally perceived as sincere, including her report of having behaved in a "weird" fashion after the alleged abuse. Asked how she knew that she had acted "weird," she said that her mother had told her so. At the jury "waived trial, father "was found not guilty of all charges.
In all of the cases, a final judicial or prosecutorial determination of non-misconduct was made. In three of the cases, judicial determination was assisted by formal social service agency input. Three cases were handled by Family Court alone, one case was processed by concurrent Jurisdiction by Family and criminal Court (in which the criminal charges were prosecuted to a not guilty verdict), two cases were handled by both Family Court and District Attorney's office (no prosecution was made in either case, and one case was prosecuted in criminal court alone (charges were dismissed).
Discussion
An earlier publication (11) has discussed the nature and etiology of psychiatric regression in adults during domestic relations litigation. Such regression in adults has instinctual, defensive, and behavioral components. Each component is unique in its degree of regression in an individual caught in a specific domestic tangle, and the whole regressive syndrome was seen as potential rather than as inevitable.
The hypothesis was offered that a primary dynamic etiology was the loss of a "parenting fantasy" which had served to restitute in psychic function or early developmental losses. This hypothesis serves to account for abrupt appearance of some of the " out of character," regressed behavior which is often seen in otherwise intact people who become caught up in contested domestic relations litigation.
One aspect of potential regressed behavior on the part of adults is an increased focus on sexuality, as well as a maladaptive amalgamation of bitterness, vindictive anger, or loss with sex. These emotional forces accrue great power to generate aberrant sexual actions by adults. Marital breakdown as one form of family disorganization, and the social isolation that often accompanies "involuntary single parenthood," are additional causative factors in adult sexual actions that can be abusive to children.
All of the above factors bear on situations in which sexual aberrations can or do occur. But sometimes the actions have not occurred, and such factors also bear on parents' or step-parents' nonvalid perceptions of abuse as a regressive phenomenon in its own right. Step-parents are drawn into the vortex too, and become active participants as is demonstrated in three of the cases discussed above. Step-parents' nonsexual fantasies are central to the operation of "reconstituted" families, as are their reactions or sensitivities to issues of loss, blame, failure, control; and territoriality.
It is equally noteworthy that children's reactions to stresses of marital breakdown can contribute to nonvalid reports of sexual abuse such as the cases reported here. In children, family turmoil is well known to elicit regression of analogous variety: in affective instincts, in defensive adaptations, and in behavior. Children have no "parenting fantasy" to lose, but marital breakdown presents them with unavoidable real and intangible losses that must be of even greater magnitude than those their parents sustain.
For children of divorce, in addition to the primary experience of tangible emotional loss, they are confronted with actual intrapsychic conflicts beyond their realistic capacity to resolve. "Actual" conflicts, whether tangible or not, are often presented to children for their opinions or choices; they may involve issues of custody, visitation, or property/financial matters. Intangible conflicts of divided loyalty, children's sense of failure or guilt about the failure of parental marriage or happiness, or inexpressible sadness or anger are even thornier issues.
The doctrines of "expressed preference of the child" in domestic civil litigation and "right to testify" in criminal and/or child abuse litigation have generated increased resort to such use of children as witnesses in litigation, irrespective of a child's more basic right to be cared for in supportive fashion by all of the adults around him, including the legal system.
In many cases, a child. witness's competency to testify may well be impaired by the existence of cognitive/intellectual or emotional conflicts. (12) This is especially true in cases of criminal prosecution or alleged intra-family incest when the child victim testifies against an alleged parental or close-relation perpetrator. Testimonial impairment in such cases goes far beyond the truism that no witness is fully accurate.
Elaborate "preparation" of a potential child witness (13), including rehearsal of testimony and role-playing does nothing to resolve or mitigate such conflict in the child's mind. In some cases, a child has been taken into an unoccupied courtroom and has been encouraged to recite anticipated testimony while sitting on the trial judge's bench.
Potential causes for regression in a child's developmental level of emotional instinct during domestic breakdown involve, among other possibilities, the following:
- impact of loss and the child's idiosyncratic vulnerability to it based in part on the child's pre-existing developmental level;
- emergence of punitive or primitive guilty feelings in the child for "causing" the divorce, with impulses toward self-recrimination;
- loosening of Oedipal restrictions through loss of traditional, restraining family structure;
- existence of relatively less taboo'd sexual(ized) opportunities through relationship, with step-family or other cohabitors.
Potentials for regression in defenses in children at times of stress are now a traditional element of the psychiatric literature. Less well-remarked is the truism that divorce should be expected to evoke regressions in children because of its stressful nature. Many otherwise sophisticated parents are genuinely surprised that the children react "so strongly." Some slippages in developmental staging of defenses (or adaptational maneuvers) in children include:
- resort to fantasy, with sexual and/or reunion themes;
- increased credulousness, related to increased need for replacement of depleted dependency gratification;
- increased susceptibility to influence by caretakers, related to need for security and acceptance;
- decreased ability to achieve ambivalent internal representations of object relations, and concomitant inclination to perceive relations in polarized/split concepts.
Potentials for such increased primitivity or regression in instinct and/or defensive structure in children leads to the likelihood of some variety of regressed behavior for a greater or lesser time. Examples of such regression include:
- increase in aggressive behavior, including frank resort to aggressive acting out to discharge unpleasant affect;
- regression in motor control (sphincter control or walking ability in younger children, gastrointestinal tone or handwriting capacity in older children, etc.);
- regression in developmental level of speech and/or learning ability, evident either at home or at school;
- increase in elemental pleasure-seeking behaviors, including overeating or increase in masturbatory activity;
- search for immediate or indiscriminate satisfactions, including petty thievery or sexual behaviors which may be linked so directly to emotions of sadness and loss that they cannot fairly be described as formal "acting-out."
In all of the potentialities listed above for children, the basic theme is that a child faced with domestic turmoil is thrown into acute (or chronic) severe stress which creates a ripe setting for regressed psychic function and/or behavior by the child. In other words, the child may misinterpret the actions of grownups (toward each other or toward the child him/herself); or the child may affirmatively act out some of the child's own anxiety in ambiguous but worrisome fashion (e.g., the child who masturbates after visits with a non-custodial father). These regressions are sometimes, but not always, more obvious in younger children.
It is entirely possible for otherwise ambiguous activities then to be elaborated by the child. (14) or other reporters into genuine, truthful, but nonvalid perceptions of abuse. A poignant emotional reality is that children in such situations are not "lying" but are not "telling the truth" either in the customary or testimonial sense. The child may have sufficient abstract concepts of right/wrong or truth/falsehood to qualify as a competent witness in general, but in the particular matter at hand the child may well be incapable of distinguishing an "objective" truth from inevitable subjective interpretations.
Lying is a separate and later developmental capability of children which involves knowing use of mistruths with the intent to deceive. It often appears in the late latency age range. This may have been the situation in case 3, which involved the oldest alleged victim in this series.
In early latency years, discerning the difference between "make-believe," and a "lie," and a child's genuine belief that happens to be inaccurate (including some wishes by the child) is extremely difficult. The emotional stress caused by domestic relations problems makes such distinctions even more difficult in children caught up in domestic turmoil.
The psychiatric point of view (15) aims to discern and clarify motives, and then to explain them, not just to report. This should take into account the phenomenon that a child may serve as a relatively passive screen for projectional fantasies by adults who are regression-prone under the influence of domestic stress at first, but that the child may later on become an active protagonist on his/her own in the drama. As noted above, the child may be a producer of an ambiguous report which then gets magnified and projected back onto the child in a "positive feedback loop" which increases the ultimate distortions. The children in this series were not thought by any investigator to have been consciously, deliberately "brainwashed," and with the possible exception of the teenager in case 3 they were consistently perceived by everyone as sincere.
Additional sources of potential regression in domestic relations litigation are to be found in attorneys and in the adversary system itself. On occasion, attorneys become over-involved in cases and supply some of their own interpretations and motivations for litigation. Such was the case with the X family described above. It is understandably difficult for everyone involved in domestic relations cases to remain "passionately detached" at times when potentially lurid matters are discussed. There are fine lines to be drawn between representing a client (including the State as client for prosecutors), attending to the rights of children who are not clients; trying to serve the ends of an abstract concept of "justice," and being manipulated.
Finally, the adversary system itself has inherent limitations when the task at hand requires evaluation of family situations which contain a network of conflicting loyalties. Often there are no clean-cut adversaries and parties cannot meaningfully be distinguished on one "side" of a case or another; sometimes the same party has two conflicting interests in the same case. This is often true of children caught up in incestuous families.
The adversary system tends naturally to generate "part-investigations" with the hope that a modified trial by combat will reveal the most truthful party. Often, there is little discerning revelation or evaluation of the mixed motives of a reporter; or if there is concern about such motives, full examination may be impossible. In case 7 above, it was impossible to uncover all of the mixed motivations of the seven-year old girl who testified against her father at his rape trial, though most of the trial participants sensed that there was more to the story than the criminal court was presented with. Rules of evidence do not always do full justice to human entanglements in civil litigation either.
Recommendations
Five clear-cut recommendations emerge from the discussion above:
- Evaluators charged with examining children who have been involved in stressful, domestic situations and who are involved in allegedly abusive episodes should obtain as much data on the children as possible from all available sources: educational, psychiatric/medical, extended family; etc. Domestic relations cases are unfortunately fertile ground for nonvalid perceptions and/or allegations of misconduct of all forms.
- It is essential for any evaluator of a reportedly abused child, especially one involved in domestic relations litigation to gather information from all previous or concurrent investigators, treaters and examiners. This is true even if such persons will not seem to have immediately relevant information on the case at issue; it is the way in which they have been utilized which may be as revealing as what task they are performing with the family. With the X family, mother's use of fragmented counseling/neurological services provided early indication of her mixed compliance-evasion patterns.
- There should be less emphasis on what a reported victim of abuse says or on "fact-finding" in evaluations. There should be more emphasis on the illumination of motivations of both victim and "prime movers" in the case: why are they doing and saying whatever they are? This is not at all to cast doubt on their truthfulness but to clarify the interplay between their emotions, their statements, and their actions, which is what psychiatry is all about. Evaluators, including interpreters of psychological tests, should be exquisitely aware of their own biases and presumptions.
- When a nonvalid accusation of sexual misconduct is suspected, psychiatric evaluation should rest on affirmative psychodynamic grounds, not mere anecdotal material. In addition, independent factual investigation should corroborate the psychodynamics.
- Finally, it would seem from this series of cases that Family Court, with its emphasis on civil procedures and its "network" orientation, is to be preferred as a forum for evaluation of child sexual abuse cases rather than the criminal courts. Criminal Courts are hamstrung by the need not to involve a defendant in the evaluation of the victim and vice versa. Family Court operates on the premise that in sexual abuse cases, a victim and perpetrator usually will continue a relationship long after the legal case is completed.
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