Alice Miller, child abuse and mistreatment

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Followup to your question
Tuesday January 09, 2007

my response:

i have not asked my patients if they were beaten in childhood, mostly because my patients are still in childhood (i am a pediatric cardiologist, so my patients are children), and parents almost always are with their children at the clinic visit. unless i saw physical evidence of beating, i do not feel it would be an appropriate question, though i might be wrong, since i know physical and verbal abuse is far more common than is widely perceived. unfortunately my time is somewhat limited, since i already take a rather detailed history detailing any possibly cardiac symptoms, testing is sometimes required, and many other factors may be involved, such as unhealthy eating habits, lack of sleep, lack of exercise, stress with peers, teachers, etc.

occasionally, when i sense a serious situation, i will interview the child and the parent separately, and during these interviews, the child will usually open up more to what exactly is going on with the parent.

i think what i do have to offer my patients is sincere compassion and understanding. i also offer specific techniques that can help improve their symptoms of chest pain or dizziness, often involving deep breathing techniques, and i sometimes make specific suggestions to the parents to back off a bit, or for the parents to join in the deep breathing/relaxation exercises. i also make myself available to teens, giving them my page number so they don't have to be alone and can contact me directly at any time (my partners think i'm crazy to do this). i believe that just being connected to an adult who listens and cares is very healing, and most of my patients (at least those without structural heart disease) have complete resolution of their symptoms in a short time.

i can often sense a lot of tension between teenager and parent, and it seems to help everyone when i explain that becoming your own person is a normal, healthy part of development. whenever possible, i also try to use humor. i often point out to the child that for some reason we don't understand, when kids turn 13, parents go through a stage where they become really annoying, awful people, saying all kinds of stupid things, but it is very likely they will go back to being normal people again when their child turns 19.

i am also very interested and concerned about the abuse that is built into our medical system. besides the suffering that occurs with illness, there is far too much additional suffering because going through the system is an abusive experience itself. just when people are most vulnerable and in need of compassion,they are faced with registration, insurance issues, invasive, expensive studies, but then worst of all, a widespread lack of compassion among doctors and nurses.

unfortunately, i have first-hand experience about this because of the difficulties we had when my daughter developed diabetes and other medical conditions. my experience is that if doctors don't know what is wrong, they usually either sign off the case, or else they blame the patient. when my daughter experienced severe nausea for weeks, we were told that she may be feeling anxiety and maybe we were too overbearing (the correct diagnosis was celiac disease). before she was diagnosed with diabetes, i asked several doctors if her symptoms of jitteriness could be a precursor to diabetes, and i was repeatedly reassured that she had "cabin fever" or nothing at all. what hurt the most wasn't that they didn't know, it was they acted like we were all just making up these symptoms to annoy them, when it's their job to help figure this stuff out.

one day i was trying to find meaning in the many difficulties we encountered with my daughter's health issues and dealing with the health care system. suddenly, it dawned on me that i never really understood the fear and anxiety my own patients were going through, and i resolved to connnect my own frustrations with what my patients might be feeling. now, when i sense fears from children and parents, i share my own story, which helps me find meaning in my own struggles, and by showing compassion to my patients that i myself didn't experience, i am able to heal my own scared inner child.

what i have learned from this is that even if i don't know or understand exactly what is going on, i will explain things the best i can, and then remind families that i am a human being, but i promise that i will do everything humanly possible to figure out what's going on, to take excellent care of their precious child to the best of my ability, and i point out that we are all partners together in a team with the goal of bringing health and healing to the child. i feel lucky to have a kind of loving extended family, full of compassion and understanding, all doing our best.

d. t.

AM: You write: I have not asked my patients if they were beaten in childhood, mostly because my patients are still in childhood (i am a pediatric cardiologist, so my patients are children), and parents almost always are with their children at the clinic visit.
If I were a pediatrician, I would ask EVERY parent whether they spank their children and tell them never to do this. Even and precisely in the presence of the child. I would tell them that a spanked child grows up in fear, pain and suppressed rage that at least for many hardly can be expressed in another way than through illness. Why should a permanently scared child NOT become ill?

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