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Vulnerable Children
Three Studies of Children in Conflict: Accident Involved Children, Sexually Assaulted Children and Children with Asthma
Lindy Burton
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Vulnerable Children
Three Studies of Children in Conflict: Accident Involved Children, Sexually Assaulted Children and Children with Asthma
Lindy Burton
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About This Book
Originally published in 1968, this book was an experimental investigation into some personality characteristics associated with three types of child problem behaviour. The behaviour of the children in school is described, and their underlying personality needs, as evinced by the stories they told to the author, are assessed. The behaviour at home of the asthmatic and road accident children is examined and their early developmental history traced. The part played by prolonged environmental stress, constitutional vulnerability and transitory needs is considered.
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Part One ROAD ACCIDENT INVOLVEMENT IN CHILDREN
CHAPTER II Road Accident Involvement in Children
Road accidents occur for many reasons. Where they involve a vehicle and a pedestrian, the vehicle may be faulty and become out of control, the driver may be negligent, and the pedestrian careless; or all three may to some extent be responsible.
The reasons for the negligence of driver or pedestrian may again be various. Lack of physical co-ordination, neurological, ophthalmological and physical defect, and unpredicted hazards may singly or jointly be invoked as reasons for the occurrence. Not so frequently mentioned, outside clinical practice, is the notion that the personality of the driver or pedestrian may also have contributed to his involvement in the accident.
It was impossible to estimate the extent to which any or all of these factors had played a part in the road accidents of the twenty children who were studied, all of whom had to go to hospital for treatment of fractures received in the accidents. Instead, this study attempted to estimate the degree to which these children conformed with one another in personality needs, and differed from their peers in this respect.
An attempt was made to relate these needs to the cause of the accident and to explain them in terms of the childâs development history, the motherâs personality and her avowed attitude to the upbringing of her child. The accident was then seen, not as a chance occurrence, but as an almost predictable part of the childâs total development.
Road accidents, rather than other forms of accidental self-injury were selected for study, because they represented accidents in an area in which most children had been instructed to take especial care. To take risks climbing trees is a socially acceded characteristic of childhood, to take a risk on the road is repeatedly stressed as being dangerous, stupid and blameworthy. Consequently, where carelessness on the roads had been exhibited it was felt that this âcarelessnessâ was more likely to be caused by unconscious motivations rather than by pure chance.
Another aspect of road accident involvement which makes it a particularly suitable area for acting out from the childâs point of view is its dramatic nature. Road accidents cannot be ignored or passed over by those in the environment, as can other, more domestic accidents. Also, by their frequent involvement of another person or piece of equipment, they afford the child a situation in which blame can be placed elsewhere and a semblance of innocence maintained.
The concept of accident involvement, rather than that of accident proneness, was selected for investigation in this study because no accurate estimation of the degree of an individual childâs proneness seemed possible. So many accidents to children occur within the home and remain unreported, representing a serious source of error to any investigator, working on the official figures alone (W.H.O. Report 1957), and trying to select, for the purpose of comparisons, groups of high accident and low accident children.
In addition, a pattern of frequent accidents to children at home may well represent careless parents (Lancet, 1948, 1.758), (Smid and Logan 1956), or a dangerous environment, rather than a series of specific actings out on the part of the child.
These suggested difficulties in estimating the rate of accident repetition in children may well explain the paucity of studies in this area. By contrast to the well documented field of adult accident proneness (Le Shan 1952), studies of the dynamics of child accident involvement are almost non-existent. A further explanation may lie, as Finch (1951) points out, in the fact that for the adult means of dealing with inner and outer drives and needs have become much more rigid and unchanging than for the child; a pattern of accident proneness must take time to develop. Consequently, one would presume that proportionately fewer children than adults would display such a pattern.
It seems reasonable to suppose that where a long history of accidental self-injury can be traced the chances of discovering morbid psychological causes are greater than where one simply considers an individual who has been involved in one major accident. However, Dunbar (1944) contended that persons who have had one major accident are statistically more likely to have anotherâi.e. they will be more prone to accidents. This study was therefore begun on the assumption that the personality dynamics precipitating one accident would be essentially the same as those observed in people who were accident prone.
The study subsequently offered some degree of validation for this assumption. In this group of completely unselected fracture cases due to road accidents in school age children, fifteen percent already had a history of one or more other major road accident, and 25 percent had had major accidents at school or on the road.
From such a small sample as the one investigated in this study, it would be foolhardy to generalise about the personality dynamics of all road accident victims. However, from the statistics made available for the year in which the study was completed, both by the Royal Ulster Constabulary (1963) and by the Royal Society for the Prevention of Accidents (1963), and from the World Health Organisation Report on accidents in childhood (1957), this sample would appear to be fairly representative in terms of type of accident, the age and sex of the child sustaining it, and the distance from home at which it occurred.
Trends in child road accidents appear to be:
(1) A significantly greater number of boys sustain road accidents than girls.
(2) More children under seven years of age have accidents close to the home, and as pedestrians.
(3) Children over seven years of age have accidents further from home. There is also an increase with age in the number of cyclists injured.
(4) Most child pedestrians sustain accidents between the ages of three to twelve, the greatest number of accidents occurring to six to seven-year-olds. Most child cyclists sustain accidents between six to fourteen, the greatest number of such accidents occurring to fourteen-year-olds.
The personal details of the accident involved children in this group appear to be consistent with those of the larger studies. Of the twenty children, sixteen were male and only four female, a difference which is highly significant (·006, using the Sign Test). All the under seven-year-olds met with accidents close to their own homes and as pedestrians. Of the seventeen children over seven years of age at the time of the accident, thirteen had accidents some distance away from home. Whilst the mean age of the whole group was nine years and nine months, the average age of the seven cyclists in the group was over eleven and a half years, as compared with an average age for die thirteen pedestrians of eight and a half years.
CHAPTER III Clinical Speculations and Formulation of Basic Hypotheses
Clinical speculations
In considering the dynamics of personality functioning which make for accident involvement, the clinical literature stresses two major concepts:
(1) accidents which are unconscious self-injuries because of guilt feelings, âattempts at suicide with insufficient meansâ (Klein, 1932);
(2) not unrelated to the first, accidents which occur when defences against authority-hostility conflicts fail.
Further and secondary causes are mentioned, for example the avoidance of an unpleasant task, or the gaining of some form of reward, or attention, or sympathy, as the result of an accidental injury.
Suicides with insufficient means. As early as 1914 Freud made the suggestion that an accident might not be due solely to unpredictable and uncontrollable external forces but rather to unconscious psychological factors subserving deep-rooted personality needs.
In the Psychopathology of Everyday Life (1914) he quotes numerous examples of accidents, which whilst appearing entirely fortuitous, nevertheless could be interpreted as âunconsciously purposiveâ (Menninger, 1936). The following is one example.
A young married woman gave an exhibition of dancing one evening for an intimate circle of relatives. Her jealous husband was gready annoyed and reproached her by saying that she had behaved like a prostitute. After the incident she spent a restless night and in the morning decided to go driving. She chose the horses herself, refusing one team and demanding another. She refused vehemently to allow her sisterâs baby with its nurse to accompany her. During the drive she was very nervous and warned the coachman that the horses were getting skittish and finally when the animals really produced a momentary difficulty, she jumped from the carriage in fright and broke her leg, while those remaining in the carriage were uninjured.
As Freud points out, the accident prevented her from dancing for a long time.
Eleven years later in his Collected Papers (Volume III), Freud offers further examples of what he then viewed as an âindirect attempt at suicideâ. One of these is the case of Herr K., a former lover of the patient Dora, and latterly the object of her accusations and hostilities, who came one day face to face with her on a street where there was much traffic. Confronted with the woman who had caused him so much pain, mortification and disappointment, âAs though in bewilderment and in his abstraction, he ⊠allowed himself to be knocked down by a carâ.
Further examples of unconsciously purposive accidents were supplied by Abraham. In his Selected Papers on Psychoanalysis (1927) he cites the case of a girl who from childhood had an exceedingly strong affection for her brother. She grew to womanhood, measuring every man by the standard of her brother, and had an unhappy love affair which left her depressed. Shortly after this she twice got into serious danger through her own carelessness on a climbing party, much to the wonderment of her friends who knew her to be a good climber, not likely to fall twice in safe and easy places. It appeared later that at the time she was in hospital, she was accustomed to go for a walk about the grounds: there was a ditch dug in the garden which she used to cross by a plank bridge, although she could quite easily have jumped over it. At that time her beloved brother was to be married and this was much on her mind. On the day before the wedding, as she was out walking she sprang over the ditch, instead of crossing by the bridge as usual, and did it so clumsily that she sprained her ankle. âLater on these self-injuries occurred so frequently that even the attendant began to suspect that there was something intentional in them. In these minor accidents her unconscious was obviously expressing the intention to commit suicide.â
Neither Freud nor Abraham explicitly state the mechanisms underlying these indirect attempts at suicide, but from the examples selected, it seems certain that the suggested root cause was guilt produced by non-permissible sexual or aggressive longings, ameliorated only by self punishment.
Karl Menninger (1936, 1938) provides one of the fullest expositions of the psychoanalytic idea of indirect suicide. Ranking purposive accidents as focal suicides, he maintains that they occur when the ego refuses to accept the responsibility for self-destruction.
The guilty act stimulates the conscience to demand of the ego a price. In some instances this price is a (self-inflicted) death penalty. In other instances it seems to be less severe, and we may assume that the local self-mutilation is in some way or other a ransom and protects the ego against the imposition of the death penalty⊠The principle of sacrifice is operative here so that in a sense the individual submits himself to the possibility or certainty of accidents in which he has at least a chance of escape rather than face a destruction which he fears even though it may threaten even in conscience.
Menninger stresses the notion that frequent involvement in accidents may be a periodic payment for the continued indulgence in forbidden erotic and aggressive tendencies, and notes the similarity between this and the obsessive and compulsive techniques used by neurotic patients to offset melancholia.
He quotes the case of a former patient who had twenty-four major disasters in his life, including the accidental poisoning of his own child, and three successive car accidents at the same spot in which each time his car was entirely demolished. He wrecked successively eleven cars. It was possible to discover that his guilt arose in part from terrific unconscious wishes to kill certain members of his family.
Whilst stressing that the essential elements of accidental self injury are those of other forms of self destructionâaggression, punition, and propitiationâMenninger introduces in one of his case histories some suggestion of secondary elements.
He writes of a man who, fearing he had acquired gonorrheal infection of the eye, shaved a splinter of wood into this eye, âThis immediately gave him occasion for more solicitousness, about the eye, more visits to the doctor, more appeals for sympathy, and more justification for aggression.â
That these same motivations might apply with equal force to children was suggested by Melanie Klein (1932, pp. 25-6, 146). She quotes the case of Trude, aged three years and nine months, who after the birth of a sister, âwanted to rob her pregnant mother of children, to kill her and to take her place in coitus with the fatherâ. Trude exhibited aggressive behaviour towards the parents coupled with extreme fear of retribution, and âused to manage to hurt herself in some way almost every time before she came for her analytic hour. It turned out that the objects against which she h...