David A. Wolfe
When you are a child of abuse and no one listens to you and no one confirms
that you are being abused, you feel like you are insane.
—HECHE (2001, p. 223)
Child maltreatment is a tragedy of human error and human circumstances. At its most basic level, child maltreatment denotes parenting failure—a failure to protect a child from harm, and a failure to provide the positive aspects of a parent–child relationship that can foster development. The responsibility for this failure is shared not only by the individual parents for not adequately providing for their child, but also by society, for not adequately providing the parents with supports and safety nets. About 3 million reports of child maltreatment are made to child protective services (CPS) each year (U.S. Department of Health and Human Services [DHHS], 2001), confirming that such acts represent a major and urgent public health concern. With this conern comes a keener sense of responsibility for research-based assessment, prevention, and treatment efforts directed toward the child and family.
Most maltreating parents do not have psychotic or other serious mental illness, and some show no apparent psychological or personality dysfunction (Francis, Hughes, & Hitz, 1992; Wolfe, 1999). However, many have problems in related areas of depression, anxiety (including posttraumatic stress disorder [PTSD]), domestic violence, substance abuse and dependence (alcohol, other drugs, or multiple substances), personality disturbances, social isolation, and poverty, with several of these problems overlapping in both community and clinical samples (see Wekerle & Wall, 2002a, 2002b). For instance, first-degree relatives of depressed, abused children have a ninefold greater likelihood of lifetime depression than controls (Kaufman et al., 1998). Although some of the co-occurring disorders are treatable, appropriate treatment is often lacking due to numerous obstacles. Even if maltreatment is detected by formal systems, the focus of professional attention is on child protection and risk assessment, with fewer resources available for treating adult disorders or circumstances. This narrow response may fail to protect against further abuse by overlooking significant risk factors, such as substance misuse or parental disorders (English, Marshall, Brummel, & Orme, 1999).
Although child characteristics may play a factor in parental abuse (Wolfe, 1999), a child is never responsible for being abused (deYoung & Lowry, 1992). Child abuse is an adult act, and without this adult behavior the child would have fewer developmental problems and disorders. Moreover, maltreatment-induced psychopathology in childhood is preventable. Given its association with health risk behaviors, medical illness, and greater rates of psychiatric and medical services needs, child maltreatment may be the single most preventable and intervenable contributor to child and adult mental illness (DeBellis, 2001). Once a child has been maltreated, there may a long and winding road ahead to support a transition from victim to survivor, and from surviving to living.