BOOK AND MEDIA REVIEWS
CHILDREN AND VIOLENCE: THEWORLD OF THE DEFENSELESS
By Einar A. Helander
334 pp, $90
London, UK, Palgrave MacMillan, 2008
ISBN-13: 978-0-2305-7394-9
THIS PITHY BOOK EXAMINES THE ISSUES OF TRAUMA AND POVERTY in the lives of children through an international lens. Having worked for 30 years in 94 countries on 5 continents, Einar Helander brings a wealth of direct experience with children, family homes, schools, child-focused institutions, and Health and Social Welfare ministries from around the world. He asserts that 5 to 10 million children (primarily girls younger than 5 years) “die annually because of intentional neglect or outright murder” (p xviii).
In part 1, Helander presents the tremendous magnitude of the problem, concluding that “half of the world’s population have been victims of childhood violence before the age of 18” (p 4), and he provides an excellent discussion of the definitions, materials, and methods determining his conclusions. It becomes clear that getting information about this ubiquitous worldwide problem is not an easy task. Surveillance of these commonplace problems (eg, 300 million children worldwide go hungry each day) is challenging, owing to the difficulty of getting reliable information from developing countries, where population growth abounds. “Mirrors of the Past” provides an astounding history of childhood trauma over the centuries.
In part 2, Helander estimates that there are approximately 10 million children in residential institutions and highlights the historical atrocities of underdeveloped as well as developed countries. The book identifies children without homes or families to care for them. Worldwide, orphans number 112 million (the United Nations Children’s Fund [UNICEF] estimates that African orphans number 38 million [11 million resulting from AIDS]; Asian orphans, 65 million [5 million resulting from AIDS]; and Latin American orphans, 9 million [2 million resulting from AIDS]). In addition, child soldiers number 300 000; street children, 25 million; refugee children, 15 million; child laborers, 218 million; and child prostitutes, 400 000. The International Labor Organization estimates that half of the 218 million children aged 5 to 14 years who are without families to care for them work full time. Helander clearly articulates the longlasting negative physical, psycholo-gical, and social effects experienced by children raised away from their parents. Part 3 emphasizes the enormous prevalence of violence against children and highlights the outcomes of this violence. The issue of children traumatized by violence at the hands of their birth parents is underscored, noting that most perpetrators of child abuse are the child’s parents. The book presents a number of disturbing tables cataloging the prevalence of sexual abuse, physical abuse, combined abuse and neglect, and violence against children with disabilities in various countries. In addition to the damage caused by caregiver neglect, the author highlights the concept of structural care neglect of children, ie, the failure of society to provide basic needs necessary for children’s healthy development.
Helander lists commonly known mental symptoms and social consequences of childhood trauma and cautiously estimates that violence against children has “led to life-long somatic disability for at least 300-400 million people” (p 136).
Part 4 focuses on the myriad causes of why individuals become perpetrators of violence and discusses the availability and efficacy of existing care and rehabilitation services for abused and neglected children. Unfortunately, Helander notes that the factors that could facilitate resilience in the United States (p 151) are culturally difficult to apply in developing countries (p 205), a point with which I disagree, because research indicates that these resiliency factors can be adapted to other cultures.
Part 5 notes that most countries should be embarrassed by their lack of attention to the United Nations’ treaties on human rights within their own borders. Despite ratification of the United Nations Convention on the Rights of the Child by all countries except Somalia (which has no government) and the United States, most countries do not follow these articles. Hundreds of millions of children experience cruel, inhuman, and degrading treatment. Although the World Medical Association has guidelines on ethics, large numbers of physicians do not follow these rules. Chapter 12 takes on the case of the poor, declaring that 2.4 billion lack basic sanitation, 1 billion lack clean water, 45 million have AIDS, 250 million have malaria, and 130 million children of school age lack access to basic education. The author suggests, notwithstanding the admirable United Nations Millennium Development Program, that international development aid is insufficient to correct this travesty.
Part 6 provides an antidote for the toxic influences on childhood by presenting the methods to implement a universal community-based primary prevention intervention for childhood violence. It includes strategies that everyone, regardless of where they live, can take to reduce the rate of violence toward children. These strategies consist of (1) promoting family life preparation consisting of ensuring attachment of children and parents, enhancing parenting style, and encouraging empathy; (2) promoting “child community watch” efforts in which children are monitored in homes, schools, and leisure-time activities; (3) generating publicity about the consequences of abuse; and (4) introducing laws that not only make sexual abuse illegal but also make physical and emotional abuse of children illegal while encouraging local small efforts at community mobilization to address this issue.
Because of the worldwide tragedy it outlines, Children and Violence: The World of the Defenseless is exceptionally difficult to read, and the photographs are heartbreaking. The solution at the end of the book is straightforward and reminiscent of an emerging resiliency as well as of protective factor research. Such research has found that universal prevention intervention strategies—eg, developing social fabric, ensuring strong child/parent attachments, ensuring that children have an “adult protective shield,” providing children with mastery to minimize their traumatic helplessness, and providing social skills (such as parenting and empathy skills) for parents and children—are solid strategies that can be adapted for all humanity
Carl C. Bell, MD
Community Mental Health Council Inc
University of Illinois at Chicago
Chicago, Illinois
carlcbell@pol.net
Financial Disclosures: None reported.
1. Bell CC, Bhana A, Petersen I, et al. Building protective factors to offset sexually risky behaviors among black South African youths: a randomized control trial. J Natl Med Assoc. 2008;100(8):936-944 Accessed March 25, 2009.
2. O’Connell ME, Boat T, Warner KE, eds. Preventing Mental, Emotional, and Behavioral
Disorders Among Young People: Progress and Possibilities.
2. Book Review – American Journal of Psychiatry
Paul Jay Fink, MD
Professor, Psychiatry and Behavioral Science, Temple University School of Medicine, Philadelphia, PA, MD
Recent President, the American Psychiatric Association
November 4, 2008
Children and Violence: The World of the Defenceless by Einar A. Helander
This is an important book and a great addition to the growing literature on child abuse and neglect. It is a book filled with horrible stories and pictures of the terrible things people do to children all over the world. Written by someone who worked for the World Health Organization for 30 years and who did a great deal of field work throughout the world dealing with issues of child abuse and neglect, it is a marvelous compendium of data and opinion concerning what we have done to millions of children. The numbers are staggering and as one reads through the book, one becomes aware that we are dealing with huge numbers of children who have been seriously damaged in their lifetime. They remain damaged throughout their lives, develop serious addictions and physical diseases and die earlier than most other people in the world.
If one opens to any page in the book, you will find a series of data about what people do to children and the kinds of enormously distorted and disturbed lives these children live throughout the world. As we begin to try to understand the enormous varieties of inhumane behavior towards children, it becomes an overwhelming task. In this book, we read about children who are put into institutions, children who are detained and children who are made into soldiers, prostitutes and other means of being bought, sold and used for the purposes of the adults who often kidnap them or buy them. The categories are often startling – orphans, child soldiers, street children, child laborers, refugees and displaced children, children who are trafficked and children who are used in prostitution and for sexual purposes. Each of these categories is described in the book throughout the world and is often related to poverty and severe neglect on the part of parents. The issue of neglect is dealt with very extensively.
One of the things that should be noted is there is an entire section on the ACE (Adverse Childhood Experiences) Study by Felitti and Anda and is clearly outlined as an excellent example of what happens when children grow up in a world that is distorted by violence, hatred, mental illness and other serious problems such as the incarceration of their parents. In many ways the book is quite comprehensive and addresses issues related to causes of violence as well as treatment options and community based child defense and support programs.
I am impressed with the comprehensive nature of this book, the enormous amount of research and the depth of the sources used by the author to explicate his findings, not only in terms of broad generalizations, but also in terms of specifics. The book has a remarkable ability to bring to our faces the terrible things we do to children. Keeping a child in a bed for 10 years without ever letting them get out, a bed which is too small for them in which they develop severe contractures of the legs and they cannot straighten them out, is a perfect example of the kind of horror we read about in the book. The section on child soldiers is devastating. Hundreds of thousands of children are made into soldiers, given AK-47’s and other serious weapons and sent out to war, often forced to kill their parents and forced to eat the flesh of those they kill. In many of the examples in this book, we see a clear disregard for the human nature of the children and forcing them to experience horrific parts of the world they should never see. The whole question of attachment is discussed and the need for children to have a loving environment in which to grow. None of the children talked about in this book have had that. They have been discarded, thrown out of their homes, unwanted and often they have serious disabilities that lead to their being trashed. The author says, “We need first of all to deal with a conspiracy of silence,” and that is perhaps the most critical message in this book. There is a world-wide conspiracy of silence about the damage we are willing to do to children and tolerate being done to children in every corner of the world. This results in our having millions and millions of children who are physically, sexually and emotionally abused in their own home or by their own family to those who are neglected and thrown out become street children, orphans, young warriors or prostitutes. Both of these are horrible results for the life of a child and lead to their being neglected so they are not fed, they have no place to live, they have rags to wear and by and large they are not wanted, not seen and not cared for.
The civilized world has to take notice and this book allows us all to become very familiar with the realities of child abuse and neglect that have been exposed by Dr. Helander and the World Health Organization. Over and over again he says these are children who have been neglected, abandoned or assassinated. All three words are for most psychiatrist and other professionals working in the humanities disastrous and horrifying words. These things that are happening to these children should not be happening and for us to neglect, abandon and kill them is perhaps the worst revelation we see in the book, page-by-page, over and over.
I recommend this book be in the library of every psychiatrist so child abuse and neglect can be taken seriously as one of the underlying etiological factors in the cause of physical and mental illness. The work of Felitti and Anda in the ACE Study and others is a serious indictment of who we are and what we are doing to our children. It’s important for us to begin to set the record straight and to get the world to pay attention to the needs of children and the fact that children, above all, need to be loved, protected and cared for. That is something we have known and postulated for decades. Now is the time to get rid of the realities in this book and stop hurting, damaging and killing children and let’s make sure we find the right way to begin to get the entire world to wake up to the needs of children and begin to take care of them in a way that is not only proper, but of inestimable value. The author says the only way we are going to get peace in this world is to stop the violence against children because children who are violated grow up to be violators if they grow up at all.
Paul Jay Fink, MD
3. Revue d’epidemiologie et de sante publique, 2008
Professeur (ret.) J-J. GUILBERT
MD, PhD(educ),DHc.
15 avenue du Mail
CH – 1205 Genève
BOOK REVIEW / E. HELANDER Children and Violence / Palgrave Macmillan, UK, 2008 / ISBN978-0-23057394-9
It IS a “text book” that should become a must for all categories of students (and former students) around the world. It is indeed a must for all citizens of the world with a conscience.
The author is a strong spokesman for human rights and solidarity. His 30 years of field experience of pervasive violence in the “world of the defenceless” is the basis for an impressive and rather terrifying description of children abuse and neglect, inhuman and degrading treatment.
It is an archaeological search in the depth of human evil behaviour leaving the reader with many disturbing questions about the avalanche of domestic and community violence an expression of force in a situation of inequality. It hurts to read that “Parents are the main group of perpetrators not only in poor families but also in affluent ones”.
The book is carefully researched via an extensive study of published scientific literature and combines history, science, statistics and personal observations with focus on children.
Supportive data shows that violence is extremely common in all cultures, societies, economic, social and religious strata.
– Three billion people are the traumatized victims of childhood sexual, physical, psychological forms of abuse.
– Over one billion as a consequence become disabled or meet a premature death.
– 5-10 million children (less than 5 years old), mainly girls, die annually because of intentional neglect or outright murder.
– 10 million abandoned children are in, often dilapidated, residential institutions.
After such a monstrous diagnosis the author is still able to say “Yet there should be hope”.
The aim is “Helping people, who have nothing to eat or who are afraid of being beaten up, in their struggle to get out of poverty instead of a globalization of power in the hands of the few and rich”.
It implies “To fight against corruption, cover-ups or inaction inside the judicial system, against the uncaring public attitude, against the non-compliance by Governments with their Human Rights obligations where many perpetrators escape justice” and to “Open the media to the realities they are now hiding”.
The author recommends “school education and massive public education campaigns for the practice of empathy, social and emotional skills, and basic knowledge about the causes and consequences of child violence”.
The expected role of World leaders is that if they do not take measures to “mobilize communities” and create “a positive social environment” then “the alternative will be to create more prisons for the perpetrators and more hospitals for the victims (…) avoiding to solve the root problems”.
The author provides a convincing description of a “Disability prevention programme” and a “Community-based rehabilitation strategy (CBR)”, both lauded by H. Mahler former Director General of WHO.
Such training programmes include “policies, planning, programme design, service delivery systems, quality/cost control methods and human rights”. The successful delivery of public care is related to the appropriate managerial training of the professionals ( Alma-Ata , 1978).
The author says that “Such primary prevention is possible” but that it “will only be effective if major alterations in human behaviour and in the culture of our societies occur”. This is a very big “if” indeed. It will take a few generations to see real improvements. “Plus ça change plus c’est la même chose”.