Justice and Psychiatry

To restrain individuals from violating the persons and property of others, every society has developed a body of rules and procedures, usually called the criminal law, setting forth the proscribed acts and the penalties for them. Assault, battery, and murder are, of course, high on this list of proscribed acts.

In Western societies, injurious acts generally fall into one of two categories: felonious offenses or justifiable acts of self-defense (including protection of self and community). In modern times, a third, or intermediate, category (whose ancestry may be traced to the Renaissance and beyond) has gained increasing recognition. In it are placed the offenses of persons said to be insane or mentally ill. Acts and actors so classified form a bridge between prohibited and permitted acts, criminally guilty and innocent persons. Like all hybrids, this category exhibits characteristics of both of its parents; the upshot is that the people classified as mad rather than bad are considered at once not blameworthy but in need of restraint by organized society, and blameworthy but nevertheless not appropriate subjects for the penalties of the criminal law.

The principal aim of the editors of The Battered Child is, as I see it, to enlarge this intermediate category of violent acts and malicious actors by including in it all the physical injuries which parents inflict on their children, and all the persons who engage in such conduct.

The book treats mainly two topics. One is the awful things parents do to their children’s bodies (the editors do not deal with the awful things they do to their children’s personalities); the other is what ought to be done about these things. Helfer and Kempe — respectively, assistant professor, and professor and chairman, in the department of pediatrics at the University of Colorado School of Medicine in Denver — assume, and indeed insist on, two quite unrelated propositions: one is that the apparent victims of “the battered child syndrome” — that is, the children — are physically ill and hence require pediatric care; the other is that the accused victimizers — that is, the parents — are mentally ill and require psychiatric care. That injured children need medical care is irrefutable. That the parents also do is, however, less obvious. Yet everything the editors say about battering parents and do with them rests on this unexamined and unproven premise.

“Children who have been abused,” writes Katherine B. Oettinger, chief of the children’s bureau, Department of Health, Education, and Welfare, in the foreword, “require protection and rehabilitation, and their parents need professional guidance to help them understand, accept, and cope with their parental roles.” But is it not morally objectionable to tell adults that they need “professional” (meaning “psychiatric”) guidance when they themselves not only do not ask for such guidance but explicitly reject it?

Although not a single one of the battering parents described in this volume requested psychiatric help, Helfer asserts — and this assertion is repeated by other contributors until it becomes their veritable battle cry — that the physician “must realize the parents usually want help.” Since this is not true, and since Helfer knows it isn’t, he resorts to a psychiatric redefinition of “help.” “In regard to the parents’ desire for help,” writes Helfer, “it must be admitted [sic] that there are times when they do not demonstrate this desire too clearly.” One mother countered Helfer’s offer of “help” with: “You can go straight to hell!” But Helfer remains unmoved, secure behind his professional barricade: If the physician is convinced that this fact [that all battering parents want help] is true, the parent will eventually demonstrate, in some manner, his or her rather desperate longing for some form of assistance.”

Now it seems to me that when physicians (or priests or politicians) assure people that they are trying to help them, that is not very interesting, because obviously they would not say that they are trying to harm them, even if this were the case. Why, then, this recurrent emphasis on helpfulness, not only in this volume, but in all psychiatric propaganda? And why are such therapeutic promises so gullibly accepted? I think because the rhetoric of helpfulness conceals, as almost nothing else does, the perennial conflicts and tragedies of human life — the conflicts between parents and children, husbands and wives, teachers and students, whites and blacks, men and women, capitalists and Communists — and makes it appear as if these could be resolved if only everyone showed a little goodwill. Utter nonsense? Of course. But that does not matter. Hope springs eternal. If not God and the priest, then surely Science and the physician will relieve man of his awful burden — the freedom to manage his own life and the responsibility for what he does with it.

As one would expect, this rhetoric of scientific salvationism is displayed most brilliantly in the chapter on the psychology of battering parents written by two psychiatrists. Brandt F. Steele, a professor of psychiatry at the University of Colorado Medical Center and a training analyst, and Carl B. Pollock, an assistant professor of psychiatry at Colorado, begin anecdotally by telling us how “. . . unwittingly [they] were launched on a long-term investigation” of battering parents because their “first patient, an effusive, hysterical woman with a vivid, dramatic history and way of life, turned out to be a challenging ‘gold mine’ of psychopathology. Our feelings alternated between horror and disbelief that she had actually fractured the femur and skull of her three-month-old daughter.”

Terence (the philosopher) said: “I am a man, nothing human is alien to me.” This maxim was embraced by and became the motto of the leaders of the Enlightenment. The leaders of the new psychiatric Dark Ages have inverted this so that it reads: “I am a (normal) man, nothing alien (abnormal) is human to me.” Thus do mental health workers (and their faithful followers) impart meaning to their lives by depriving the lives of “mental patients” of theirs.

“Rarely,” Steele and Pollock continue, “a patient [sic] was lost because we had no way of holding on to anyone who was extremely recalcitrant or uncooperative.” To the authors, a person is a “patient” even if he is not physically sick and rejects the sick role. Moreover, he is a “voluntary” patient even if he is compelled to see a physician.

By and large the involvement in our study of parents was quite voluntary on their part, even though on first referral they were “told” to see us. In a few instances, maintenance of contact with us depended upon the admonition from a judge that the parents’ probation or the return of their child to them was contingent upon seeing us and a report from us.

When even these measures fail to ensure “cooperation,” Steele and Pollock employ other methods of coercion.

All of them [the parents], even those who came voluntarily asking for help, were quite reluctant and evasive and contact had to be contrived [sic] by whatever possible means and on ad hoc basis. . . . Several attacking parents were hospitalized in our psychiatric unit. Hospitalization was determined as much by a desire to have the opportunity for close observation as by medical necessity.

If such mental hospitalization is not a way of holding on to a recalcitrant patient, what is it?

If this book doesn’t put the fear of psychiatric meddling in the reader, nothing will. He cannot say he hasn’t been warned. Elizabeth L. Davoren, a psychiatric social worker at the Colorado Medical Center, reports that home visits “involve driving long distances to find nobody at home. Home visits are having the door shut in your face on cold, windy days. . . . Home visits are attempting to get some semblance of a dialogue going above a blaring television set. . . . Bin home visits are gold mines of useful information.”

And so it goes through most of the volume, except for the two concluding chapters on the legal aspects of child abuse, one written by Monrad G. Paulsen, professor of law at Columbia University, the other by Jack G. Collins, an inspector in the Los Angeles Police Department. These authors emphasize, first, that parents who assault their children are, whatever else they might or might not be, lawbreakers; and second, that the relationship between such parents and their children is antagonistic rather than cooperative, so that what is beneficial for one might be harmful for the other.

Each of these chapters (but none of the others) is followed by rather tasteless “Editors’ Notes” in which Helfer and Kempe reiterate their rejection, as immoral and impractical, of the adversary model and judicial procedure for arbitrating human conflicts, and their preference for the therapeutic model and bureaucratic procedure. For example, they assert that “every person involved must constantly keep in mind the child’s best interests.” What they evidently mean is that even a defense attorney retained by a parent accused (conceivably falsely, by neighbors, relatives, physicians, or social workers) of battering his child must not place his loyalty to his client above his loyalty to the child’s “best interests” (as if the child’s best interests could not be to secure the acquittal of his innocent parent). “In our experience,” write Helfer and Kempe, “more satisfactory dispositions are made when attorneys, parents, welfare personnel, and physicians meet together in the judge’s chambers and, using proper legal formality [sic], discuss all the aspects of the case in question.”

What “case”? Helfer and Kempe seem quite unaware how, in their zeal to protect the injured child and to claim his mother and father for the benevolent ministrations of psychiatry, they deprive the parents of their right to prove themselves innocent! I need hardly argue that for persons accused of crime, as parents of allegedly abused children are, a psychiatric star chamber camouflaged behind “legal formality” is no substitute for the protections of a truly adversary system of criminal law. “The right to representation by counsel,” observed Justice Abe Fortas in Kent v. United States (1966), “is not a formality. It is not a grudging gesture to a ritualistic requirement. It is of the essence of the justice.” Of course, Fortas means judicial justice. But to the editors of The Battered Child, this kind of justice is nothing but a hindrance to the proper performance of their work, much as a dirty operating room might be to surgeons. In short, their goal is not judicial, but psychiatric, justice.

Inevitably, the reader’s opinion of this volume will depend almost entirely on his concepts of the individual and the state, and the means the state ought to use to restrain the individual from harming his fellows. If the reader believes that there are two kinds of human beings, sane and insane, two kinds of harmful acts, bad and mad, that there ought to be two systems of social controls utilizing the police power of the state, judicial and medical; and, most important, if he reserves to himself the right to determine which acts and persons should be placed in each class, then he will regard The Battered Child as an important contribution to the protection of both battered children and battering parents: the former from the latter, and the latter from the consequences of their mental illnesses.

On the other hand, if the reader believes that all human acts are motivated and understandable; that from the point of view of formal social controls, acts are either legal or illegal; that there ought to be only a single system of social controls utilizing the police power of the state, judicial; and, most important, if he believes that the state has a duty to treat the citizen with dignity and respect — eschewing coercing him if he obeys the law, and prosecuting him as an accused criminal if he is suspected of breaking it, even if the victim happens to be the alleged victimizer’s child — then he will regard The Battered Child as still another disastrous addition to the growing contemporary literature on man’s dehumanization of his fellow man in the name of mental health.