The professionals’ resistance to seeing
The fact that doctors and other health workers tend to resist seeing and acting was documented by a project undertaken in the Department of Paediatrics at Ullevål University Hospital in the late 1970s (5). It was also documented that health, social and educational professionals make use of various mechanisms to avoid seeing. This has later been confirmed in studies from other countries (6).
These mechanisms involve survival strategies, over-identification with the parents, downplaying, rationalising, distancing, projection and problem displacement. By over-identification we ascribe to the parents more positive characteristics than they actually have, and this prevents us from seeing the realities. This will often result in downplaying the risk that the child is facing. We distance ourselves from the child’s vulnerability, anxiety, suffering and loneliness. If we see something that worries us, we find ways to rationalise and explain away the things we surmise. We can distance ourselves by retreating, referring the case to someone else – «this is not my patch» – and place the responsibility on someone else’s shoulders.
When facing an extensive and complex set of problems, with domestic violence, substance abuse and mental problems, and where the child in the family has behavioural problems, it is easy to shift the attention onto the child’s behaviour. The case of Christoffer is a prime, though tragic, example of problem displacement. Serious neglect and physical abuse were redefined into a diagnosis of ADHD, and active efforts to investigate the relationships in the family and the parental functioning were replaced by medication (7). In this way, the professionals did not have to assume the difficult and painful task of relating to Christoffer’s loneliness and fear. They did not have to relate actively to the parents, the child welfare services or the police.
According to Torleiv Ole Rognum, professor of forensic medicine at the University of Oslo, five deaths occur each year as a result of serious neglect, head injuries or asphyxiation (8). It has been well documented that physical abuse is a common cause of head injuries or fractures in infants (9) – (11). Long-term injuries are common (12). Bruises have been shown to be a key marker of physical abuse (13).