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Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Friday, October 22, 2010

Chewing Off the Hand: Demonizing Nathaniel Craver

The Virginia psychologist Ronald Federici has found a new and scary way to blame adopted children for their own injuries. Commenting on the death of a western Pennsylvania boy who had been adopted from Russia, he has referred to another child who “chewed off his own hand” and to children with no sense of pain (http://www.washingtonpost.com/wp-dyn/content/article/2010/10/20/AR2010102004021.html and many other Internet sites). Federici and the defense attorneys for the adoptive parents, Michael and Nanette Craver, argued that the child, re-named Nathaniel, had injured himself fatally. An Associated Press article stated the Cravers’ argument that Nathaniel had suffered from Reactive Attachment Disorder, which, according to the article, “includes a tendency to injure oneself. “

Let’s consider each of these statements. Is it possible for someone to chew off his hand or to feel no pain? Individuals with the genetic disorder Lesch-Nyhan syndrome do chew off their lips and tongues as well as having movement and other problems. Schizophrenic patients have been known to gouge out their own eyes or break off teeth. And there are genetic disorders in which people unfortunately have no sense of pain and accidentally injure themselves as a result, for instance by failing to notice they are touching a hot stove until they smell burning flesh. Individuals with Hansen’s disease (leprosy) lose sensitivity in affected body parts and injure themselves by accident.

In all these situations, the sufferer shows many behavioral and physical symptoms in addition to self-mutilation or frequent accidental injuries. And, it’s clear, none of these problems is caused by adoption, although there’s a minute chance that a child adopted in infancy could have a disorder that is not yet noticeable. By the time any child reached Nathaniel’s age, seven years, ordinary observation and well-child care would have detected a set of problems that were not limited to self-injury, and which don’t seem to be mentioned at the trial . So, when the irrelevant statement about hand-chewing is brought into the discussion of Nathaniel’s death , our response should be, “what do the two things have to do with each other?” In my opinion, the purpose of this scary example is simply to distract attention from the real evidence about the events that led to this boy’s death. The “he did it himself” defense has been seen before in these cases; it was claimed that 2-year-old David Polreis beat himself to death with a wooden spoon, and even the very public videotaped death of Candace Newmaker was claimed by some to have been a deliberate act on the child’s part, for the purpose of punishing her therapists.

To continue the analysis: Is there any truth whatsoever to the statement that Reactive Attachment Disorder involves “a tendency to injure oneself”? Reactive Attachment Disorder is, of course, described in the Diagnostic and Statistical Manual of the American Psychiatric Association. But, no, no such behavior as self-injury is linked with RAD in DSM volumes of any vintage, nor is any such change predicted for DSM-V. This is proof by assertion at work. The Cravers and their attorney have made this statement without the slightest foundation in evidence, which they get to do in their efforts to be acquitted; it’s now up to the prosecution to ask the questions that will reveal that there is no truth to the statement, and the jury to pay attention to the facts.

In an interview with the Harrisburg Patriot-News , Federici also stated that Reactive Attachment Disorder is only a symptom “of a much larger and deeper disturbance”. This statement, like the previous one, would come as a considerable surprise to the committees that work hard to revise DSM periodically. While it’s presumably true that any behaviors, desirable or undesirable, are indications of underlying characteristics, it’s further proof by assertion and further distracting scare tactics to claim that the symptoms of Reactive Attachment Disorder indicate a nameless badness beyond DSM’s ken.

Let’s resist these attempts to depict Nathaniel as a demonic child, one of a group of terrifying, inhuman children who mutilate themselves horribly and cause unfair accusations of their loving caregivers. Let’s focus instead on the reality of this child’s life and the likelihood that he injured and malnourished himself.

And let’s hope the jury focuses on those issues, too.

9 comments:

  1. The only thing I remember about somebody feeling no pain was in popular culture very recently. It was Lisbeth's stepbrother Niedermann (or rather halfbrother). And yes, he had a genetic condition. I don't know how these things were picked up in Sweden or Germany where he was.

    Proof by assertion! I wonder if this is why children with reactive attachment disorder might also be over-represented in the borderline personality disorder/bipolar affective disorder categories?

    Hope the prosecution asks some hard questions.

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  2. I wonder.

    Do you happen to know if Federici has ever testified for the prosecution in defense of a child against parents?

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  3. That's a good question, Campbell, and I really don't know. Not all of these things make it into the newspapers, and even when they do, it can be hard to find them.

    Maybe Federici would like to come on here and tell us about that issue, or explain his remarks in the Craver case.

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  4. There's a genetic condition, hereditary sensory neuropathy (also called congenital insensitivity to pain) that makes an individual unable to feel pain. It usually is detected quite early on, though (the infant doesn't cry at shots or other painful procedures).

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  5. I can't comment on this case, because any allegation like this needs to be taken very seriously, but I can comment on Reactive Attachment Disorder.
    Having cared for a child with RAD, and subsequently joining a RAD support group with parents and adult sufferers of RAD, I can say that self-harm is a prominent feature of this disorder.
    An event that stands out in my mind is this particular child arguing with another child at a big group picnic about the benefits of having a broken arm (he was getting a lot of attention) she stood up, stuck out her arm and proceeded to throw herself down onto it. She calmy stood and said "now you'll have to take me to the hospital to get a cast on too". This child was 7 years old. She was intelligent, articulate, and had no other conditions. She could feel pain, but her will was strong enough to hold in her reaction if she chose to.
    This particular child had been neglected / abused by her mother and step-father until the age of 3, but had been in a stable, loving home, receiving regular therapy, since then.
    Again, I can not comment on the Craver case, but if you are interested in information on Reactive Attachment Disorder, there are plenty of online groups where you can speak with not only parents, but adult survivors for another perspective.

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  6. I don't deny that there are children who injure themselves. I do point out, however, that self-injury is not one of the diagnostic criteria for Reactive Attachment Disorder as described in DSM. I'm well aware that there are quasi-professional groups who have put forward their own definitions of attachment disorders and provided checklists of assumed diagnostic criteria. Many of them make their diagnoses with the help of the Randolph Attachment Disorder Questionnaire (RADQ), an instrument that has never been validated against blind clinical diagnoses and which in fact has failed to discriminate between groups of children in a well-designed empirical study.

    The framework you suggest-- that the child's will was so strong that she could bear discomfort if she wanted to-- is a dangerous one. That perspective suggests to parents that their job is to exert their authority until they are victorious over the child's wilfullness. This is the kind of thinking that led to Cassandra Killpack's death from forced water ingestion. It's certainly what I was referring to when I said Nathaniel Craver was demonized.

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  7. Dr. Federici does not claim, as far as I could see, that this child could not feel pain. Post-institutionalized children frequently exhibit self-abusive behaviors - as part of a support network for kids adopted from ex-Soviet orphanages I have corresponded with dozens of families who have seen this in thier kids. I have seen kids rock, trying to smash thier heads repeatedly into walls, - and they do not have any sensation impairment.

    OK... it may not be an official "symptom" of RAD according to the DSM... but lots of disorders have symptoms that are in addition to the official lot.

    Why would a kid abuse himself if it hurts? There have been many suggestions: Self stimulation when there is a history of neglect (any sensation, even pain, is better than nothing at all)? If the child has a history of being abused, might she try to hurt herself before someone else can do it? ... or to make herself unappealing if she has been sexually abused? Issues around attention? Control? Anger?

    There are so many factors that come im play with children who are severely neglected, neurologically impaired, and unattached.

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  8. No, Federici did not say that, or even talk specifically about Nathaniel Craver, whom he had not seen. However, he referred to the hand-chewing-off and unresponsiveness to pain as part of his comments with respect to the Nathaniel Craver case. Presumably he felt, or led the reporter to feel, that the two topics had something to do with each other.

    I would not class harmless self-stimulation like rocking together with potentially injurious behavior like head-smashing. Many, even most, typically-developing children rock, whirl round in circles until dizzy, and hang upside-down from swings. Playground equipment in general gives the opportunity for self-stimulation.

    Neither would I class head-bashing together with chewing off hands. I am far from saying that the latter could not happen, as enucleating eyes or breaking off teeth have happened, but the last three could not occur impulsively, and the hand-chewing would take quite a while and be easily caught by adult supervision. I consider it a mistake to give the public the idea that these events are either common or unpredictable. You yourself point out,by the way, that there are many reasons for self-injury other than high pain threshold. (Although I would say that the idea that a sexually-abused child wants to make herself ugly is perhaps crediting the child with a better "theory of mind" than is likely, as well as suggesting that child molesters go for attractive children rather than vulnerable ones.)

    As for whether self-injury is a symptom of RAD: it's really a problem that people like the ATTACh group have invented a whole list of symptoms that are supposed to indicate some kind of ill-defined attachment disorder that isn't RAD (cf. Elizabeth Randolph). Once you start saying that all these things have to do with attachment disorders, the next step is to say that you fix them by doing something about attachment, and then it becomes very easy to fall into the trap of assuming that coercive and authoritarian behaviors cause attachment to occur and using those to "treat" things supposed to be attachment problems. And this is where we get back to Federici, whose self-published book recommends control over children's food, restraining them in the prone position, and holding them supine in order to create attachment-- none of these ideas being congruent with what is known about the natural history of emotional development.

    Incidentally, in the English-Romanian Adoptees study-- about as post-institutionalized a group as you could get-- there were very few unusual behaviors. Delayed language development was the most common problem. And even children regarded as disinhibited in early life were most often seen as popular and outgoing by their teens.

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  9. All this stuff about RAD is just bs. These stupid people say that anyone that is up for adoption is automatically diagnosed with RAD because their parents must have abused them... Load of crap... And why all these Russian kids? Why are nearly all of the victims Russian? Someone answer THAT with intelligence...

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