On the origins of the battered child syndrome: abuse as acting out of preverbal events.

The clinical description of a chronically acting out boy, now 14 years old, physically abused by parents and especially by mother, has been the starting point for presenting some concepts on the nature and prevention of child abuse. This patient's life history included repeated hospital admissions, beginning the second month of life and lasting for periods of months. His violent acting out towards objects and people, but particularly his continuous negativistic attitudes towards parents, and his rejection of his mother and home were each time the setting for battles in the family. The role played by medical institutions in promoting child abuse through family detachment and communication loss is briefly considered.

Early psychosomatic pathology.

Early life vicissitudes and care, which are physical and concrete variables in their occurrence, but which are stored in the infant's mind in terms of relationships and emotional interplay, are basic for development in terms of body as well as of psychic orientation. Just as in psychic growth the interplay continues in the child's investment in the outside world (object), in the physical growth distorted early relationships, possibly deviated by the infant's physiological immaturities, interfere with the child's total health, and may lead to early psychosomatic pathology.

Growth.

Freud's concepts on the innate and the experiential, applied as they were essentially to the psychic structure, are discussed because, as Winnicott (1952) indicates, 'the psyche grows out of the soma almost from birth' (see also Bion, 1962). The maternal function is basic to the growth in the first months and, to a lesser extent, is basic all through the growing process, which is particularly fast and demanding during the first three years. The fact tha the 'maternal function', essential for growth in the early stage, is comprised of events which the baby either experiences or is lacking, such as bodily early contacts, being held in the arms and the quality of holding, eye to eye communication on which baby's apperception develops is underlined. The quality of early physical care is to be seen, in the author's view, as the food on which basic individual growth takes place. Deviations and distortions of growth, where no genetic and/or organic explanation may be found, have to be studied in this light. This is particularly true with young babies, where maternal deprivation is a frequent cause of malnutrition.