In the late 1980’s I was the sole provider of mental health services in a remote, rural part of the US. Although specializing in adult assessment and treatment, I was occasionally called upon to assess and treat adolescents and school age children, as there was no other clinician available in the area.
One day a school age boy was referred to me for outpatient treatment. In looking over his record at the clinic, it was clear that the boy was in severe difficulty with acting-out behavior. In the record was a psychological evaluation from a Neuropsychologist (in a distant metropolitan area) that stated very clearly that the boy needed inpatient, residential treatment for his emotional and behavioral difficulties. The report was a detailed, excellent documentation of the boy’s performance during the evaluation that supported the need for residential treatment. In addition, the report warned that without treatment the boy was at risk for more serious problems, as were the systems in which the boy functioned. The boy’s parents had exhausted their resources in trying to get help. They really wanted the child to have treatment and were unwilling to give up on him.
Having done an assessment interview myself, I brought the treatment record with me to a treatment planning meeting conducted by the ‘treatment team’ (composed of officials from school, town and county) on behalf of this boy. At the meeting I emphasized the urgent nature of the boy’s condition, supported by the report from the Neuropsychologist. I stated emphatically that my findings, during the assessment interview, were completely congruent with the Neuropsychological Evaluation.
In addition, I pointed-out to the treatment planning team that the boy’s history of separation from his mother during early childhood, one of a number of separations endured by the boy, caused him to display a serious emotional detachment and lack of relatedness when it came to his violent behavior toward others. I told them in lay terms that the boy had little capacity to be empathic or sorry toward those he hurt.
Responses, to the case I made for residential treatment required by this boy, were met with general, non-specific answers that were really non-responses. When I persisted in trying to put some definite plans into place for residential treatment, the team admitted that they were glad to have the boy go on and commit a crime so that the Criminal Justice System would assume responsibility for providing treatment; this was some treatment plan! The school, the town and the county refused to act so that the boy could be helped before his condition became worse.
Sadly, this story is only one of thousands (or more) where children with childhood problems are being overlooked, with the risk of greater violent behavior as they become adolescents and adults. K. Magid and C. A. McKelvey in their book HIGH RISK: CHILDREN WITHOUT A CONSCIENCE (Bantam Books, 1987) describe a situation in the US wherein the Mental Health System and the Criminal Justice System will be overwhelmed by children (like the boy described in this discussion) who commit crimes without any guilt, are dangerous to society and require isolation from general society for the safety of the community.
Predictions made by Magid and McKelvey are coming true, shocking most of us as we hear news reports of snipers, shooters in schools and universities, shopping malls-the list goes on and on. Our prisons are overcrowded, and our mental health system has no way of really containing these criminals either before or after they slaughter the innocent. Magid and McKelvey emphasize that children with attachment disorders (caused by separation or ineffectual parenting in early childhood) are usually untreatable after the age of seven. The treatment required for these children is intensive and requires effective clinical intervention in residential settings.
Some leaders in this country are beginning to talk about its crumbling infrastructure as it becomes newsworthy when bridges collapse, for example. The most serious, fragile infrastructure-the mental (and physical) health of children is rarely a news item, unless a politician mentions it in a campaign, or when journalists report that a child has pushed another off a balcony, beaten another child to death or committed an act of violence toward a child his/her age or younger.
When adolescents and young adults become combative in school/university shootings the question is raised “How did this person come to this destructive end?” The answer is that the violent acts of adolescents, young and older adults have their roots in childhood conditions like the one described previously. A Neuropsychologist clearly alerted others to the potential danger in this boy if he was not helped. The ‘treatment team’ chose to ignore recommendations of clinicians who identified the need for intervention. The boy was arrested eventually and he began his career in the Criminal Justice System at an early age, as do so many young people these days. This was a boy who had the benefit of being identified as a potential problem in the future.
There are many, and the numbers grow constantly, who never have the benefit of a psychological assessment or evaluation. What a disgrace this is in a nation with abundance and scientific resources. The cost is not only to the untreated children who become violent adults, but also to those they victimize in their killing sprees. Our best interest is served when these kinds of children are diagnosed early and treated effectively.
One other aspect of this tragedy is the role of child abuse in the development of “Children Without a Conscience.” Children who are abused physically, verbally, psychologically and sexually in early childhood often have the propensity to become violent as they mature. Those who do not become violent or abusive, frequently direct the abuse or violence toward themselves. As the saying goes “Children learn what they live.” The abused child identifies with the abuser in one way or the other, unless there is a therapeutic intervention to heal the abuse. Child abuse contributes to the decay of the infrastructure in the lives of the adults who carry these wounds from childhood into later life. As a clinician for many years my observation is that child abuse in the USA is more widespread than I ever thought possible. If we as a nation really came to terms with the impact of child abuse, unimaginable numbers of would have to address recollections of abusive childhoods. For so many, both in the public and private sectors, facing the devastating consequences of abuse in childhood is too painful.
Consider how long it took us to have laws regarding child abuse. That is a lengthy topic for another time, perhaps. When an excruciating case of child abuse hits the media everyone watching is outraged. These cases, like the Lisa Steinberg case, surface into public awareness for brief periods, then become remote memories, rarely considered. Why is this so? My guess is that for many this topic is just too close for comfort.
