Unanswered Questions About the Death of Maxim Kuzmin (Max Alan Shatto)

[Russian readers can find this post translated at http://yuliamass.livejournal.com/115359.html ]

The New York Times yesterday and today noted the release of results from a preliminary investigation of the death of three-year-old Maxim Kuzmin (Max Alan Shatto), a child adopted from Russia, in Texas last January. The released information declared the death accidental, associated it with bleeding from an injury to the mesenteric artery supplying blood to the intestine, and pointed to the child’s having been diagnosed with a behavioral disorder associated with self-injury.

The investigation appears to be ongoing, and so it should be. Without at all wishing to suggest that the adoptive parents intentionally killed the child, or even that they were in some way instrumental in his death, I want to point out that the statement released last Friday was by no means a full explanation. A complete explanation of the death of any young child would be desirable, especially as it might help prevent further deaths--  but in the context of deaths by injury of a number of other children also adopted from abroad, it would appear to be essential.

No investigation can provide answers to questions that are not asked, and when I think about past investigations of adoptees’ deaths I must query whether the present investigators know all the questions they need to ask in order to provide a complete explanation.

Here are some questions I would like to have answered by the investigation:

What information was provided to the adoptive parents either before or after Maxim and his brother came to them? Were they led to expect serious emotional disturbance in the children, and were they offered unconventional advice about appropriate child-rearing methods?

Who provided the diagnosis of Maxim’s stated behavior disorder? Was this done on the basis of his behavior in the adoptive home, or were assumptions made about his early experiences and the impact they would be expected to have?

What was the diagnosis that was said to be associated with self-injury? Did the occurrence of self-injury lead to the diagnosis, or was the diagnosis that had been made on other grounds then predicted to be associated with self-injury?

If there was self-injury, what form did it take? That is, did the child sustain injuries because of clumsiness or impulsiveness, or were there attempts at other forms of injury, like tongue-chewing or lip-biting?

If there was self-injury, what treatment or support was the family receiving in efforts to prevent further injury? Had the child received either medical or psychological treatment for these injuries? Had the parents received related counseling, either from the adoption agency or from any other source?

If the child was receiving any form of psychological treatment, did this include so-called “visceral manipulation” involving deep massage of the abdominal area? (Some alternative practitioners hold that emotional memories are carried in the abdomen rather than the brain and can be influenced by massage pressing deeply into the belly. This practice has occasionally been associated with holding therapy in the past; it is exquisitely painful and has apparently caused visceral injury in adults.)

The answers to these questions would help paint a complete picture of the causes of Maxim’s death. Failure of the adoption agency to provide appropriate guidance or services might indicate negligence on the part of the agency, and failure of the adoptive parents to seek help or treatment when needed might indicate that there was neglect of the children. Inappropriate diagnosis and/or recommendations by mental health professionals may be evidence of malpractice. Any or all of these difficulties could be associated with either careless or intentional actions leading to Maxim’s death.

In closing, I would like to point out that the various references made to Reactive Attachment Disorder as a cause of the posited self-injury in Maxim’s case are at best irrelevant and at worst an intentional red herring.