Freud could have been a champion -- in fact, very briefly in history he was a champion -- for uncovering child abuse, childhood seduction, childhood sexual assault, and for advancing women's rights in this regard. But unfortunately, that moment in history was brief, as Freud reversed his theoretical and clinical tracks shortly thereafter.
The time of Freud's first dramatic, controversial clinical psychology statements unveiling the issue of childhood sexual abuse relative to the aetiology (cause) of hysteria was April 26th, 1896. There would be many more controversial clinical statements to come in the years that followed but none that continued along this same 'childhood sexual abuse' aetiology path.
After 1896, Freud started to write more and more about the aetiological factors of 'childhood sexual wishes and fantasies', 'distorted memories', 'symbolism', 'dreams', 'the Oedipal Complex', 'stages of 'psycho-sexual development, and the like. But there would be no more concerted writing about the factor of childhood sexual abuse -- whether it be 'rape' and/or 'seduction' -- like there was in this mostly succinct and direct paper on April 26th, 1896, read to a very disbelieving and angry medical audience at the time.
..........................................................................
Jeffrey Masson writes on this most dramatic and controversial change of events in his equally controversial book, 'The Assault on Truth: Freud's Suppression of The Seduction Theory' (1984, 1985, 1992). From Chapter 1 of Masson's book:
"I had shown them the solution to a more than thousand-year-old problem-- a caput Nili." -- Sigmund Freud, 1896.
On the evening of April 21st, 1896, Sigmund Freud gave a paper before his colleagues at the Society for Psychiatry and Neurology in Vienna, entitled 'The Aetiology of Hysteria'. (The paper has been included below as Appendix B.) Freud realized that in giving this paper he would become "one of those who had disturbed the sleep of the world." The address presented a revolutionary theory of mental illness. Its title refers to Freud's new theory that the origin of neurosis lay in early sexual traumas which Freud called "infantile sexual scenes" or "sexual intercourse in childhood". This is what later came to be called 'the seduction theory' -- namely, the belief that these early experiences were real, not fantasies, and had a damaging and lasting effect on the later lives of the children who suffered them.
.........................................................................
Now there are at least three or four theories of speculatively interpreting what happened back in 1896 -- and thereafter.
Theory 1. Masson's Thesis: Freud basically 'ran out of ethical courage'. He went charging into this 1896 meeting like a lion -- and he came out of it more or less wimpering like a lamb. Maybe not totally. Nor immediately. But still this theory asserts that Freud basically 'chickened out' of his sexual abuse theory because it was met with too much resistance in the (totally male) medical community. These men in the medical community had the power to destroy Freud's young medical career by ceasing to 'refer' patients to him, and in so doing, they had the power to economically destroy Freud as well. According to this Masson theory, Freud knew this, caved in to the medical pressure exerted on him, and eventually 'significantly modified' his theory in such a way that these doctors ceased to exert career and financial controls over him. Freud's various 'modifications in clinical theory' -- his 'Screen Memories' theory, his 'Dream Theory', his 'Wish Theory', his theory of 'forgetting' and 'jokes', his 'Oedipal' theory, his 'Childhood Sexuality' Theory, his 'Psycho-Sexual Stages of Development' Theory, his Libido Theory, his 'Psychic Apparatus' (Id, Ego, and Superego) -- all of these and more accumulated into what became together known as 'Classical Psychoanalysis'. But by this time, Freud's earlier 'Traumacy' and then 'Seduction' Theory had to all extents and purposes -- become dead and buried.
Some Psychoanalysts would argue that Freud still kept these two earlier theories at least partly alive in particular circumstances, but the vast majority of the evidence seems to indicate that the Traumacy and Seduction Theories were 'marginalized' in Classical Psychoanalysis at best, 'suppressed' in Masson's words, and to all extents and purposes -- dead and buried, a product of 'extinction' by earlier 'ethical' and/or unethical', 'right' or 'wrong' forces.
.........................................................................
From the internet...
Classical Psychoanalysis
Theory of Illness
-Three-Stage Compromise Model of Mental Illness:
- Stage 1: Primal repression in the pregenital stages
- Step A: Id prompting (wish)
- Step B: Ego defends (counterwish)
- Stage 2: Return of the repressed content following
pubescence
- Stage 3: Compromise deflection (conversion) to
“symptoms”
Theory of Cure
Freud’s original theory:
1. Understanding of hidden meanings = insight (Freud
tells the secret and patient is obliged to change)
2. Client had to be free and open with therapist – relax
level of censorship (let the patient talk – whatever comes
to him/her = free association -> psychic determinism)
Freud’s final theory:
1. The neurotic is a person with significant primal
repressions, including those surrounding the
unresolved Oedipal complex
2. In therapy, this same acting-out process occurs in
the transference of feelings onto the therapist
a. Transfers affectionate, friendly feelings for the
therapist as a person
b. There are positive transferences of an erotic,
sexually lustful nature that are actually aimed at
the image
c. There are negative transferences of a hostile,
death-wishing variety that are also aimed at the
image rather than the person of the therapist
3. Neuroses stem from a personal dynamic, and it is
only the neurotic who can directly confront his/her
own unconscious and try to end the lack of
communication between the private realms of mind
4. As the neurotic client moves through
psychoanalysis, he/she develops an artificial or
transformed neurosis within the four walls of the
consulting room
5. When we speak of positive or negative feelings
being transferred to the therapist via imagoes, we are
also saying that libidinal or hostile
cathexes are taking place
6. The patient in psychoanalysis comes gradually to
remove libido from object cathexes in the environment
and from the symptoms manifested in the body and to
redirect this free libido onto the relationship with the therapist
Therapy
- A scientific investigation in addition to a curative process
- Rules for dream interpretation/analysis:
1. Do not take the manifest content of a dream
literally, because it never reflects the unconscious
meaning intended.
2. Present various portions of the dream contents to
the client as a prompt for free association, and do not
worry about how far this line of investigation takes
you from the original dream story.
3. Never lead or suggest things about the dream to
the client; wait until several dreams and/or free
associations to dream contents suggest the direction to
be taken in making interpretations.
- Patient lies on sofa, Freud sits behind head of patient - out of sight (Freud did not like being stared at for eight hours a day)
- Met several times/week, for at least a year
- Pay was discussed up front and charge would occur for even missed appointments
- Saw patients for 50 minute hour - took notes between sessions (not during)
- In earliest sessions, Freud turned lead to patient: “Before I can say anything to you I must know a great deal about you; please tell me what you know about yourself.”
- Freud began instructing on basis of psychoanalysis around the 5th or 6th session (very much against independent reading/studying of psychoanalysis by patient)
- Advised patients not to make important decisions during course of treatment - to limit making of errors in life decisions
- Hold out on interpretation until client is one step short of making it himself or herself.
- Psychoanalysis ends when both analyst and analysand decide to stop seeing one another.
To contact the web manager:
E-mail Colin M. Burchfield, Ph.D.
Use the above link (e.g., image) to purchase my favorite textbook on clinical psychology. Use the below (e.g., image) link to purchase the book from which much of the information on this page came.
Links to Resources on Classical Psychoanalysis:
Psychoanalysis Related Organizations
Psychoanalysis Related Journals
Psychoanalysis Related Books
..............................................................................
Theory 2: This thesis is probably held by most orthodox and classically trained Psychoanalysts: That Freud's 'new' theoretical modifications after he slowly 'dropped' his 'Traumacy' and 'Seduction' Theories were warrented by 'new' clinical evidence and were superior theories based on this 'new' and/or 'accumulative' clinical evidence. Freud's biggest argument seemed to be that these 'alledged' incidents of 'childhood sexual abuse/seduction' were just far too common for Freud to believe that they were all 'real'; that conversely, they represented 'distorted memories and real fantasies of unconcsious childhood wishes on the part of his female clients and that these fantasy-wishes were a "normal" part of their evolving childhood and adult sexual process'. In particular, the little girl's evolving 'romantic/sexual fantasies' towards her father became labelled by Freud in Classical Psychoanalysis as 'The Oedipal Complex'.
..........................................................................
Theory 3: The DGB Psychology Theory: That Freud overgeneralized on his Repressed Memory Theory, he overgeneralized on his Repressed Fantasy/Wish/Impulse Theory, he overgeneralized on his Traumacy Theory, he overgeneralized on his Seduction Theory, he overgeneralized when he abandoned both his Traumacy and Seduction Theory, he overgeneralized on his Oedipal Theory, and he overgeneralized on his Sexual-Libido Theory. In effect, both Pre-Psychoanalysis and Classical were/are full of overgeneralizations that to this day have not been fully compensated for except by differing elements of 'Post-Freudian' and 'anti-Freudian' schools of psychology, each of which have their own unique and particular way of focusing on human behavior and human pathology -- and each of which only sees a 'certain element of the whole of human life and human mental pathology' just like Classical Psychoanalysis still does. As theorists, we all play 'The Fitting Game' (Fritz Perls) where we all make 'boxes' and 'generalizations' and 'theories' most of which generally see 'elements of the whole' but never 'the entire whole'. We all come up with these 'generic theories' -- some better or worse than others -- but none ever 'perfect' enough to encompass the whole of 'human life' and 'human pathology'. There are different ways that we -- meaning theorists and/or therapists -- can play the fitting game. Mostly, a therapist is taught one particular theory and sticks with that theory. However, we can also change and/or modify our theories according to the clinical cases and information that we receive.
The worst thing we can do is try to 'force' our generic theory on case information that doesn't fit the theory. This is a Cardinal Sin amongst theorists and therapists -- and when we are dealing with a theory that handles clinical information that is potentially as emotionally volatile and devastating as The Seduction Theory (or its opposite, The Oedipal Theory) -- with potential legal ramifications to boot -- it is imperative for theorists and/or therapists to either get this information 'absolutely right' and/or at the very least to not make any claims of 'absolute rightness' when the clinical information is based on 'subjective, narcissistically biased testimony' -- or even more dangerously -- therapist interpretation (that is potentially based on the therapist's own projections and/or counter-transferences) that could be right or wrong or anywhere in between. If some father's legal, family, and/or social reputation is at stake -- and the consequences involve the very real potential of his life being ruined -- the people who get involved in this type of case better make sure that they have an iron-clad case of what they are talking about. There is absolutely no room for ethical and/or legal error here because the potential consequences to a 'falsely accused and/or convicted man or woman are so great.
One only has to be reminded of the horrific case of Dr. Charles Smith who's 'seemingly expert' testimony helped to convict numerous parents of 'killing their own babies' -- only to find out significantly later that much of this testimony was fraught with errors and 'not expert at all'. The doctor was totally discredited, his medical license was revoked, and numerous cases came back up for re-investigation -- with some people having spent years in jail already -- based on Smith's 'bad' testimony.
While there are some differences in the two professions here -- childhood forensics vs. psychotherapy -- still, there are many similarities in issues, logic vs. illogic, and horrific consequences that deserve to be seriously looked at and analyzed for their potential for error...Here are two articles relative to the 'Dr. Charles Smith' horror show...
.......................................................................
Court lets dad appeal Dr. Smith baby case
Judge waives deadline to challenge conviction
January 7, 2009
Tracey Tyler
LEGAL AFFAIRS REPORTER
The Ontario Court of Appeal is giving Richard Brant a second chance to prove he didn't kill his 2-month-old baby, contrary to highly damaging findings made by disgraced pathologist Dr. Charles Smith.
Brant's deadline for appealing his 1995 conviction expired more than 13 years ago, but the court yesterday agreed to an extension. Lawyers for Brant, 36, have until Friday to file documents formally setting the appeal process in motion.
"The applicant (Brant) has explained the delay and there is obvious merit to the appeal," Justice Marc Rosenberg said in a written endorsement yesterday, after hearing submissions from Brant's lawyer, James Lockyer, and Crown counsel Alison Wheeler.
Wheeler did not oppose Lockyer's request for a time extension. Brant's case was one of nearly two dozen that led to a recent public inquiry into Ontario's pediatric forensic pathology system.
A team of international forensic experts found Smith, described by Brant's trial lawyer as "the king" of child death investigations, made mistake after mistake and reached findings not supported by evidence.
In Brant's case, Smith concluded 2-month-old Dustin Brant's death in Nov. 1992 was a homicide from blunt-force trauma, likely the result of being shaken. In his findings, he contradicted a neuropathologist who performed an autopsy and found Dustin died of respiratory failure and pneumonia.
In an affidavit filed with the court, Brant, who had originally been charged with manslaughter, said he agreed to accept an offer from the Crown and plead guilty to aggravated assault because he felt he stood no chance against Smith, then a powerful and persuasive witness.
Brant served six months in jail.
Speaking with reporters outside court yesterday, Lockyer said his client and many other parents who were convicted of killing their children on the basis of Smith's testimony share another common denominator. Most, like Brant, had little money.
To this day, Brant, who now lives in New Brunswick, doesn't have the money to fight to clear his name.
As a result, Rosenberg ruled yesterday that Lockyer will have his legal fees covered by the province, as allowed by the Criminal Code, at a rate of $225 an hour. His law student will get $35 an hour.
Toronto Star
...............................................................................
the charles smith blog
Monday, June 9, 2008
Extraordinary Article: Dr. James Le Fanu: Why Have Women Been Wrongly Convicted Of Killing Their Children?
My attention was recently drawn to an extraordinary article entitled: "Expert witnesses, suspect science and dead babies: Why have women been wrongly convicted of killing their children?"
The author is Dr. James Le Fanu - a medical columnist for London's Daily and Sunday Telegraph and winner of the Los Angeles Times Book Prize for "The Rise and Fall of Modern Medicine" published by Diane Publishing Company in 2001;
The article was published in a feisty medical publication called "Spiked Health" on June 27, 2005.
As a practicing physician, Le Fanu saw first hand the emergence of the dubious proposition that there might be a hidden epidemic of abusive injury of children emerged in the 1980s with the description by British paediatricians of two covert forms of child abuse - factitious illness and smothering - and its tragic results.
Le Fanu's insightful article is preceded by the following quotes:
'PLEASE, IF THERE IS ANY WAY YOU COULD HELP WITH OUR SITUATION, BY YOURSELF OR ANYONE YOU KNOW, COULD YOU PLEASE GET IN TOUCH. WE CAN HONESTLY SAY, HAND ON HEART, WE HAVEN'T DONE ANYTHING TO HURT OUR BABY. WE ARE NOW BEEN [SIC] ASSESSED AND WE GOT TOLD [SIC] THAT WHEN WE GO TO THE FINDING OF FACTS HEARING AND WE STILL INSIST WE HAVEN'T DONE ANYTHING, OUR TWINS WILL GO UP FOR ADOPTION.';
LETTER FROM PARENT
-------------------------------------------------------------------------------
'FOR ME, THE UNUSUAL FEATURE IS DEATH SO SOON AFTER BEING SEEN WELL, THE FACT THAT THERE HAVE BEEN PREVIOUS DEATHS IN THE FAMILY AND THE FACT THAT HE HAD HAD AN EPISODE OF SOME SORT ONLY NINE DAYS BEFORE HE DIED THAT CAUSED HIM TO BE ASSESSED IN HOSPITAL, BECAUSE THOSE FEATURES ARE ONES THAT ARE FOUND REALLY QUITE COMMONLY IN CHILDREN WHO HAVE BEEN SMOTHERED BY THEIR MOTHERS. SO THE DIAGNOSIS FOR ME, THE CLINICAL DIAGNOSIS, WOULD BE THIS WAS CHARACTERISTIC OF SMOTHERING.';
TESTIMONY OF PROFESSOR SIR ROY MEADOW, R V CANNINGS, MARCH 2002;
-------------------------------------------------------------------------------
THE AUTHORITY OF MEDICINE DERIVES FROM ITS SCIENCE BASE, SO IT WOULD BE REASONABLE TO ASSUME THAT DOCTORS WHEN CALLED ON TO GIVE THEIR EXPERT OPINION IN COURT WOULD HAVE A THOROUGH BALANCED GRASP OF THE RELEVANT SCIENTIFIC EVIDENCE. THE SUCCESSFUL APPEALS OF SALLY CLARK AND ANGELA CANNINGS AGAINST THEIR CONVICTIONS FOR CHILD MURDER WOULD SUGGEST OTHERWISE, AS DOES THE RECENT RULING OF THE ATTORNEY GENERAL THAT A FURTHER 28 CASES OF PARENTS CONVICTED OF SMOTHERING OR SHAKING THEIR CHILDREN ARE 'POTENTIALLY UNSAFE';
NOR CAN THAT BE ALL, FOR THE ATTORNEY GENERAL'S REVIEW WAS RESTRICTED TO THE CRIMINAL COURTS, AND THUS DOES NOT TAKE INTO ACCOUNT THE SEVERAL HUNDRED CASES A YEAR HEARD IN THE FAMILY COURTS WHOSE LESS STRINGENT STANDARDS OF PROOF ('BALANCE OF PROBABILITY' RATHER THAN 'BEYOND REASONABLE DOUBT') WOULD FURTHER INCREASE THE RISK OF UNSAFE CONVICTIONS. THUS THE MEDICAL ADVOCACY OF CONTENTIOUS THEORIES OF THE MECHANISMS OF CHILD ABUSE IS LIKELY TO HAVE BEEN RESPONSIBLE FOR A SYSTEMATIC MISCARRIAGE OF JUSTICE ON A SCALE WITHOUT PRECEDENT IN BRITISH LEGAL HISTORY - WITH DEVASTATING CONSEQUENCES FOR THE PARENTS WRONGLY CONVICTED. HERE I OFFER A 'MASTER THEORY' TO EXPLAIN HOW THIS EXTRAORDINARY SITUATION HAS COME ABOUT.
-------------------------------------------------------------------------------
The article proceeds as follows:
The hidden epidemic of child abuse;
Since Kempe's description of the 'battered-child syndrome' in 1962, paediatricians have become only too familiar with the burns, bruises, fractures and neglect of the child victim of abusive physical assault. The current concerns about the wrongful diagnosis of child abuse, however, centre on a trio of very different clinical situations whose defining characteristic might be described rather as one of uncertainty or ambiguity.
-- Sudden infant death syndrome (SIDS) - SIDS remains much the commonest cause of unexpected death in childhood, whose primary aetiology, despite much research, has proved elusive.
-- Childhood injuries - children are by nature accident-prone but sometimes the severity of their injuries might seem disproportionate to the explanation provided.
-- Medically unexplained symptoms - all doctors have patients whose signs and symptoms are difficult to explain.
Doctors are no different from anyone else in being reluctant to admit they 'do not know'. Why, for example, might SIDS affect two or more children in the same family, or how might a seemingly trivial accident cause an acute intracranial injury? Some might thus be unduly susceptible to the notion that the uncertainties arise not from their lack of knowledge or clinical skills but from parental concealment - that each of these ambiguous clinical situations is potentially a form of hidden or covert abuse inflicted by parents in such a way as to hide their intentions from external scrutiny. Further, these clinically ambiguous situations are not uncommon, which would suggest that child abuse is both more prevalent than is widely appreciated and perpetrated by even the most apparently respectable of parents. Paediatricians clearly have a major responsibility in identifying these concealed forms of abuse if they are to protect children from further injury or death.
The evidence for a hidden epidemic of child abuse;
The proposition that there might be a hidden epidemic of abusive injury of children emerged in the 1980s with the description by British paediatricians of two covert forms of child abuse - factitious illness and smothering. Roy Meadow, in his pioneering paper on Munchausen's syndrome by proxy, described two cases illustrating a phenomenon, familiar now but puzzling at the time, where mothers sought the sympathy of doctors and nursing staff by fabricating the symptoms of a perplexing illness in their child that warranted repeated hospital admissions and investigative procedures. In the first case the mother contaminated her six-year-old daughter's urine specimens to simulate recurrent urinary tract infections, while in the second the mother fed her six-week-old son high doses of salt, causing him to be admitted to hospital several times with 'unexplained' hypernatraemia. Four years later Meadow reported a further series of 19 cases in which 'fraudulent clinical histories and fabricated signs' encompassed the entire spectrum of paediatric illness - bleeding from every orifice, neurological symptoms of drowsiness, seizures and unsteadiness, rashes, glycosuria, fevers and 'biochemical chaos'.
The implications of Munchausen's syndrome by proxy were twofold: it alerted doctors to the possibility of fabricated illness as a potential differential diagnosis in children with unexplained symptoms. But it also demonstrated how the seemingly most devoted of parents might, in reality, be potential child abusers. Meadow himself, commenting on the mothers in the cases he described, observed how they were 'very pleasant to deal with, cooperative and appreciative of good medical care'.
David Southall's innovative technique of covert video surveillance for investigating apnoeic episodes in children vividly confirmed the sinister reality of hidden abuse. Now paediatricians attending meetings and conferences could see for themselves the blurry black and white images of mothers caught in the act of smothering or choking their babies. Southall's study widened the spectrum of child abuse in two significant directions. It offered, in smothering, a plausible explanation for why a child might experience recurrent acute life-threatening events necessitating urgent admission to hospital. And it emphasised, once again, the possibility that some at least of those children whose deaths were labelled as SIDS might have been the victims of smothering. Southall in a further report of 30 children undergoing covert video surveillance identified 12 siblings who had died unexpectedly, eight of whom the parents subsequently confessed to having smothered. Thus parental smothering must be a clear possibility in any child with recurrent acute life-threatening events where there has been more than one unexplained childhood death in the family;
The hidden epidemic revealed;
There could be no doubt following Meadow and Southall's findings that paediatricians must have been missing a substantial number of cases of child abuse and would in future need to be much more alert to the possibility of parental harm where the diagnosis was not clear. Frequently, however, such suspicions could not be confirmed with the sort of direct evidence provided by techniques such as covert video surveillance. So how could doctors be confident that covert abuse was the cause - and convince others to take the necessary steps to protect the child from further danger?
Significantly, there were certain similarities in the signs and symptoms of children with these clinically ambiguous situations and those recorded in well-authenticated forms of abuse such as smothering, poisoning and abusive head injury. Thus it seemed reasonable to infer, by extrapolation, that these presentations were 'characteristic' of covert forms of abuse which could then be confidently diagnosed - even in the absence of any other circumstantial evidence such as bruises, signs of neglect or parental history of violence. During the 1980s the trio of clinically ambiguous situations would become redesignated as 'child abuse syndromes'. A key influence was 'Meadow's rule' regarding SIDS. While the absence of reliable pathological findings made it difficult to distinguish SIDS from smothering, Meadow argued that two or more childhood deaths in the same family, along with a recognisable 'pattern' of events (such as previous acute life-threatening episodes) was strongly suggestive of infanticide: 'two is suspicious and three murder unless proved otherwise...';
Another was the proposal that two specific presentations of childhood injury were 'characteristic' of abusive assault. Caffey's original description of shaken baby syndrome suggested that the whiplash effect of vigorous shaking offered a 'reasonable explanation' for the presence of subdural and retinal haemorrhages in severely abused children. The imagery of how the violent to-and-fro movement of the baby's head could cause bleeding of the vessels of the eye and brain proved very persuasive, and it seemed logical to infer that any child presenting with retinal and subdural haemorrhages must have been shaken - despite the absence of other circumstantial evidence of abuse;
Similarly, Caffey attributed a radiological 'bucket handle' appearance of the metaphyses of the long bones in severely abused children as being due to a 'twisting and wrenching' of the child's limbs by the parents. Subsequently, it was suggested that those children in whom abuse was suspected should have a skeletal survey for similar 'suspicious' metaphyseal lesions that were interpreted as being characteristic of abusive assault - again, despite the absence of clinical signs of fracture or subsequent radiological evidence of healing. A third was a widened case definition for Munchausen's syndrome by proxy. Meadow, in his initial series, had confirmed the diagnosis either by covert surveillance or by confronting the perpetrator and obtaining a confession. In a widened definition the presence of 'diagnostic pointers' was proposed for use in children with medically unexplained symptoms. They included:
-- Parents unusually calm for the severity of illness;
-- Parents unusually knowledgeable about the illness;
-- Parents fitting in contentedly with ward life and attention from staff;
-- Symptoms and signs inconsistent with known pathophysiology;
-- Treatments ineffective or poorly tolerated;
The hidden epidemic confirmed;
These novel child abuse syndromes, taken together, represented a major conceptual breakthrough in paediatrics. The uncertainty of clinically ambiguous situations had given place to the certainty of the single unifying and plausible diagnosis of covert abuse. The scale of the hidden epidemic then turned out to be substantially greater than had been expected, with a fourfold increase in the number of child abuse cases in the 10 years from 1978 to 1988. This was reflected regionally in an increase from 40 to over 200 cases a year in the City of Leeds while, by the end of the decade, an extra 7,500 children every year were being placed on the child protection register on the grounds of physical abuse;
Nonetheless, the facility with which the syndromes could bring to light covert abuse concealed from view their poor evidential basis. The causal link between the putative mechanism of assault and subsequent injury could be neither independently confirmed nor experimentally investigated. It might seem reasonable to extrapolate from the presence of retinal and subdural haemorrhages in the battered child that these features had the same significance in a child with no other circumstantial evidence of injury. Certainly the powerful imagery of violent shearing forces disrupting the blood vessels was persuasive, but shaking has never been directly observed or proven to cause such injuries; the supposition that they do is based on (contested) theories of biomechanics;
Rather, the legitimacy of the syndromes was predicated on two related and highly improbable assumptions, scientific and legal. The scientific assumption was that there could be no other explanation, either known or that might be discovered at some time in the future, that might explain these 'characteristic' presentations. Meadow's 'rule', for example, precluded the possibility that there might be some unknown genetic explanation for multiple unexpected childhood deaths in the same family, while the 'characteristic' pattern of shaken baby syndrome precluded the possibility of some alternative explanation for the retinal and subdural haemorrhages - such as an acute increase in retinal venous pressure from intracranial bleeding caused by accidental head injury. The legal assumption presupposed that these presentations were so specific for abuse that they were by themselves sufficient to secure a conviction - even in the absence of the sort of circumstantial evidence of violence or neglect that would normally be required to return a guilty verdict in a court of law.
Put another way, the 'characteristic' presentations of the syndromes could not sustain the interpretation placed upon them: they might be 'consistent with' but could not, by themselves, be 'diagnostic of' child abuse. Thus some at least of the parents contributing to the statistics of the fourfold rise in child abuse were likely to be innocent. Three additional factors, in particular, bolstered the credibility of the syndromes in the family and criminal courts.
The authority of the child abuse expert;
By the close of the 1980s, the leading experts in child abuse had acquired an international reputation and were thus called on to instruct and educate not just their fellow paediatricians but also the police, lawyers, social workers and judges in the child abuse syndromes. Their persuasive expert opinion, when expressed in court, was guaranteed a sympathetic hearing, while their confidence in the syndromes they had discovered was virtually unchallengeable. Further, they could scarcely accept the force of contrary evidence since to do so would require them to concede that their expert testimonies might, in similar cases, have resulted in wrongful conviction. Meanwhile the costs of the process of investigating allegations arising out of the child abuse syndromes rose to an estimated £1billion per year, with the more prominent experts receiving fees for the preparation of their reports and appearances in court in excess of £100,000 a year;
The circular argument of successful convictions;
The validity of the child abuse syndromes would appear to be confirmed by the high proportion of successful convictions that followed the courts' careful scrutiny of the allegations against parents. These convictions, however, came to rely increasingly on a circular argument - whereby the main evidence for the child abuse syndrome of which the parents were accused was that parents had been convicted of it in the past. Thus parents whose child presents with subdural and retinal haemorrhages are accused of inflicting shaken baby syndrome because, in the vast majority of cases, parents of children with subdural and retinal haemorrhages are convicted of causing shaken baby syndrome. Similarly, Meadow argued that 'the likelihood that the court verdicts about parental responsibility for [causing their children's death] were correct was very high indeed', without making clear that it was his expert testimony that repetitive SIDS was 'murder unless proved otherwise' that had been a major factor in securing those convictions;
There is a further element of circularity in the presumed pathogenesis of the syndrome of which the parents are accused. The theory of shaken baby syndrome presupposes that violent, abusive force (comparable, it is claimed, to that sustained in a high-speed road traffic accident or a fall from a second storey window) is necessary to cause retinal and subdural haemorrhages. The parents are then caught in the catch-22 of either confessing to the alleged assault (for which they might be offered the inducement 'if you say you did it we will let you have your child back') or denying it, in which case their denial is evidence they must be lying about the events surrounding their child's injury, which is then further evidence of their guilt;
The silencing of parents;
The forces of expertise ranged against the parents were formidable enough, but it is apparent too from their personal accounts that they were subjected to a series of intimidatory tactics to silence their protestations of innocence and deny the validity of their testimony as the only witnesses of the circumstances surrounding their child's injury or death. Thus parents describe how, when summoned to see the consultant to learn (they presume) about their child's progress, they were 'ambushed' with the diagnosis of, for example, shaken baby syndrome, presented to them as irrefutable fact ('your son must have been violently shaken for several minutes to cause these injuries') without any suggestion that there could be some alternative explanation.
The prompt involvement of the police and social workers would lead to further accusatory interrogations that begin from the principle that the parents must be guilty - as the doctors would not have made such serious accusations if they were not convinced they were true. The transcript of these interrogations would subsequently be turned against them in court so that any inconsistencies in their explanations of how their child's injuries might have occurred were then presented as evidence of their efforts to conceal their guilt. Parents describe the same pattern of events where they would only be informed late on a Friday evening that a preliminary court hearing had been arranged for the following Monday morning - thus leaving them the weekend to find a lawyer (who was unlikely to have any expertise in this field) to contest their child being taken into foster care;
These psychological tactics were a prelude to the yet more powerful intimidatory weapon of technical obscurantism - the description of their child's injuries and couching of the charges against them in a language in which the professionals were fluent but the bewildered parents were not. How could they hope to dispute the allegations when they did not know what was being talked about? Parents are of course entitled to seek their own expert opinion, but soon discovered that the overwhelming consensus about the validity of the child abuse syndromes meant it was very difficult to find anyone to argue in their defence; or worse, the expert reports they requested were actively detrimental to their case;
This silencing of parents was made more effective still by the rules of confidentiality that wrap the proceedings of the family courts in a cocoon of secrecy, making parents liable to a charge of contempt of court if they sought advice or support from anyone not directly involved in their case. This secrecy in turn protected the proceedings of the court, and in particular the testimony of expert witnesses, from external scrutiny while concealing from public view the spectacle of so many apparently respectable parents being convicted of inflicting these terrible injuries on their children - without any circumstantial evidence that they had done so.
For parents there was no escaping their fate. From the moment of the initial allegation against them, the alliance of medical experts, police, social workers and an unsympathetic judiciary - well organised, experienced and well financed - meant that their eventual conviction was almost a foregone conclusion. Nonetheless, the two assumptions, scientific and legal, of the specificity of the syndromes as being diagnostic of abuse remained as insecure as ever, with the courts' willingness to convict parents in the absence of circumstantial evidence of abuse resting almost entirely on their faith in the reliability and trustworthiness of medical expert opinion.
The first sign that such faith might be misplaced came in 2003 during Sally Clark's successful appeal, with the revelation of 'fundamental errors' in the testimony of Meadow and other prominent experts that had resulted in her original conviction. Their credibility was further undermined by Justice Judge's Appeal Court ruling exonerating Angela Cannings of murdering her two children. Justice Judge dismissed the central plank of the prosecution case, Meadow's claim that there had been a 'pattern of events' leading up to the deaths of children that was 'characteristic' of smothering: 'We doubt the aptness of the description "pattern"...the history of each child was different from every other child.' Further research would refute Meadow's claim (as reflected in his 'rule') that recurrent SIDS in the same family was 'extremely rare' - in other words, that in such cases the cause was likely to be unnatural. On the contrary, a follow-up study of SIDS families found two or more deaths in the same family to be 'not uncommon' with the overwhelming majority (80-90 per cent) due to natural causes. There are, it has subsequently emerged, several genetic mechanisms that could account for recurrent SIDS including congenital visceroautonomic dysfunction and cardiac dysrhythmias;
Similarly, further research has undermined the validity of retinal and subdural haemorrhages as being characteristic of shaken baby syndrome, with an evidence-based review finding 'serious data gaps, flaws of logic and inconsistency of case definition' in the relevant scientific work. Shaken baby syndrome was not, as its name implied, a 'syndrome', but rather encompassed several different forms of brain injury, with different clinical history and neuropathology, involving some mechanism other than shaking to account for the presence of retinal haemorrhages. Thus a series of independently witnessed accidents confirmed that, as parents had maintained, minor falls could cause an acute subdural bleed with the retinal haemorrhages being due to a sudden rise in retinal venous pressure (44). Further, parental histories of a preceding episode of respiratory collapse were compatible with the very different pathological findings of anoxic brain damage, with disturbance of the microcirculation causing thin subdural and retinal haemorrhages;
Meanwhile, the widened definition of Munchausen's syndrome by proxy based on 'diagnostic pointers' has also resulted in wrongful convictions, with the child's unexplained symptoms proving to be due to some rare or unusual medical condition with which the doctor was not familiar. Subsequently the syndrome would be renamed 'factitious illness' in recognition of the fact that, while some parents may fabricate the symptoms of their child's illness, the combination of unexplained symptoms and the mother's personality profile did not constitute a syndrome of abuse. Finally, radiologists' misinterpretation of normal variants of ossification in the first year of life as being metaphyseal fractures accounts for the obvious discrepancy between the findings of multiple fractures on skeletal survey and the absence of any clinical signs of abusive injury;
This serial collapse of the improbable scientific assumption that there could be no explanation other than abuse for the characteristic presentation of these syndromes has exposed in turn the equally improbable legal assumption that, contrary to sound judicial practice, it is possible to convict parents without there being additional circumstantial evidence or reasonable motive for their abusive intentions. Thus Justice Judge would, in his exoneration of Angela Cannings, draw attention to 'the absence of the slightest evidence of physical interference which might support the allegation she had deliberately harmed them'. And, again, he emphasised how 'the absence of any indication of ill temper or ill treatment of any child at any time' and 'the evidence of both her family and outsiders about the love and care she bestowed on her children' made it extraordinarily unlikely that she might have smothered them. Justice Judge's exoneration of Angela Cannings' character as a loving mother focuses attention on the moral and judgmental dimension of the child abuse syndromes, arising from extrapolation from Meadow's original description of Munchausen syndrome by proxy, that all parents are potential child abusers. Is this extrapolation plausible? The psychological profile of those who unambiguously have harmed their children reveals, as would be expected, them to be psychopaths, criminals, opioid abusers, alcoholics and so on. So when parents such as Angela Cannings, with no blemish on their character, appear as loving, concerned parents, the likelihood must be that it is because they are loving concerned parents - and very powerful evidence is required to argue otherwise.
Meadow and the proponents of the child abuse syndromes necessarily take the contrary view, and in so doing are required to portray parents' protestations of innocence as deceitful. That moral judgment, together with the failure to recognise that medical knowledge may be incomplete, meant that Angela Cannings' wrongful conviction for infanticide was almost inevitable. The question remains how many other parents have similarly been wrongly convicted of the terrible crime of injuring their children, and been robbed of their families, livelihoods and good name.
Next Post: A critique of this article by Dr Michael Fitzpatrick as published in "Spiked Health."
................................................................................
DGB
In Conclusion:
The best that we can say regarding the whole 'Seduction Theory' vs. 'Oedipal Theory' is that:
1. 'Every case is different and each case needs to be thorough analyzed and judged on its own particular merits and idiosyncrisies';
2. Beware of so-called 'expert testimony' whether it is Classical Freudian (Oedipal) or pre-Classic-Freudian (Seduction) Theory;
3. Let us not lose focus on that most important democratic principle that a man or woman is innocent until proven guilty.
4. If in doubt, remain skeptical -- and don't turn 'subjectively biased testimony' into 'righteous truth or fact'.
5. Both Freud's early 'Traumacy-Seduction' Theory and his later 'Impulse-Restraint' Ideas are deserved of proper recognition and respect -- and should be combined into a more comprehensive Integrative Theory. How tightly -- or whether at all -- one wants to hold onto Freud's Oedipal Theory is a matter for further debate. I accept it 'metaphorically' or 'symbolically' but not literally; similarily, with Freud's 'psycho-sexual stages of development';
6. Adler, Jung, Ferenczi, Klein, Fairbairn, Berne, Kohut, Perls, and others all had legitimately good things to say on much of this inter-related clinical material and all deserve to be properly read and studied for anyone who is a psychotherapist -- or thinking of being one.
-- dgb, Feb. 28th, 2009.
-- David Gordon Bain
