Dr. Richard Krugman
EndCAN Co-Founder & Board Chair
Episode 31: Eradicating Child Abuse and Neglect
In this episode, Starts with Youth’s Dayna Goren interviews EndCAN’s co-founder and Board Chair, Dr. Richard Krugman (Dick). Dick has worked in the field of child abuse for decades and relays key insights into why he believes ending child abuse and neglect is an accomplishable mission.
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Transcript of the Louder than Silence Podcast Episode #31 – Eradicating Child Abuse and Neglect
Transcribed by Adam Soisson
[Inspirational theme music plays.]
>> Lori: Thank you for joining us. In this podcast, we are real people, talking about real things. Child abuse and neglect: a topic that is all too often left in the shadows of silence, leaving survivors alone, fearful, and oftentimes without a voice. We’re having conversations to become Louder Than Silence. It is here, where we will invite you to join us and be the change needed to end child abuse and neglect.
>> Lori: This podcast is brought to you by our dear friends at The Conference Experience. The folks at The Conference Experience have really helped us out at EndCAN here for the last year and a half. They do incredible work, especially during COVID. They’ve really stepped up to the plate and helped us out so if you’re needing any audiovisual, production, or even support and help with running an event, please give The Conference Experience a call. Their number is 720 323-3273 or you can check them out at theconferenceexperience.com
>> Dayna: Alright should we get started?
>> Dick: Yes
>> Dayna: Amazing. So the first question I have for you, can you tell us a little bit about yourself and how you came into this field of work?
>> Dick: I got interested in the field of child abuse when I was a medical student. That was 54 years ago. In march of 1957 there was a professor of pediatrics at the University of Colorado School of Medicine whose name was Henry Kempe. He came to New York and gave a lecture called the Battered Child Syndrome. I was on pediatrics at the time, I heard his talk. Henry happened to be a friend of my father also, my father was a pediatrician. They did work on vaccines. Henry was working on smallpox vaccine, my father was working on measles vaccine. But Henry’s other interest was battered children and he wrote a paper that was published in the Journal of the American Medical Association in 1962 called the Battered Child Syndrome. Abuse has been around for centuries but has been pretty much ignored. It was Henry’s paper that really brought attention to the problem not only in the U.S. but in Canada and around the world. He was such an amazing person, a dynamic lecturer and a wonderful man that I decided that when it came time for me to leave medical school and do an internship in pediatrics that I wanted to go to Colorado. My wife, at the time said “I thought you were going to be a cardiologist in Connecticut” and I said “I’ve changed my mind.” Anyway, long story short because I know we don’t have much time, but I came for my internship and residency in 1968 and had such a good experience here, my wife and I both did, that after spending two years in the service I came back to Colorado in 1973. I had a number of cases where children had been abused and Henry and another man named Ray Helfer sort of taught me how to be very calm and caring and dispassionate about talking with parents of abused children. First of all it isn’t always the parents who abuse the children and they made have no idea. So I learned a lot and I was comfortable with it. Medicine is an interesting field as all fields are. You find things that depress you, things that you’re comfortable dealing with. In the 1960s I was very depressed about cancer because all of the 3 and 4 year old children who came to my pediatric ward with leukemia died and I wondered how could anybody do that work. But of course there were people who were interested in immunology and therapeutics and keeping children alive and eventually prevent cancer. They did that. 50 years later, they’ve done that. Three year olds with leukemia, 95% of them live. But I was always interested in human behavior. Whenever I had a child who’d been abused, I was always interested in what was it that led to that. So anyhow that’s when I got interested in it. Then I came back to the faculty from 1973- 1980. I was doing general pediatrics and teaching nurse practitioners and medical students and residents. Then I did rural health for a while, I spent time all over from 1977 – 1980 then I got something called a Health Policy Fellowship which took me to Washington, DC for a year. Before I left Colorado Henry, who had started the National Center for the Prevention and Treatment of Child Abuse and Neglect in Denver in our department of Pediatrics, he had two heart attacks and he was going to retire and move to Hawaii. He said to me, before I left for Washington, “I know you and if you don’t have something different to do than rural health, you’re going to get infected with Potomac fever virus and stay in Congress for the rest of your career. I need you to direct my child abuse center.” I’ve never been able to say no to Henry, I said yes and by the way he was right. If I hadn’t made the commitment to come back to Denver in 1981 I’d probably still be in Washington. But I came back to Denver in 1981 and all of the sudden I was a national and international expert in child abuse because I was directing the Kempe Center. So I figured I better learn something about it. That’s really how I got involved in it.
>> Dayna: Well that’s an amazing story. I can’t believe how long you’ve been this director, part of history in the making for child abuse and neglect. Congratulations to you and thank you so much for all you do for all the children around the world.
>> Dick: Thank you. It’s been an interesting time because I’ve now been in pediatrics over 50 years and all of the areas such as leukemia and diabetes and meningitis and all the illnesses that I took care of and were very serious and either seriously harmed or killed children back in the 1960s and 70s and 80, they’re all better. Progress has been made in every one of those areas except in child abuse where 50 years later there’s still five children a day, we think in the U.S., who die every day of abuse. It’s the one area of child health I noticed after 50 years in pediatrics that we were stuck. That’s actually why I decided, with Lori, that we were going to start the National Foundation to End Child Abuse and Neglect.
>> Dayna: That’s a great story, I’m so glad you two were able to connect forces and tackle this huge problem so thank you so much. Okay I guess you pretty much answered my next question which is what inspired you to become the co-founder of EndCAN? So we’ll move on to the next question which is you’ve said that a goal of yours is to help move child abuse be seen solely as a social and legal issue and instead as a health, public and mental health issue. What do you believe is the importance of this?
>> Dick: Well, again as I look at what is it that’s made a difference in the health and wellbeing of not just children but adults over the last half century, it’s been because there’s been research, training, prevention and most important advocacy by the parents or the children or adults who’ve had the condition, to try to make it better. When I was in the fifth grade my seatmate in our little twin desks was a guy named Bruce Campbell. One day Bruce wasn’t there and he didn’t come back. Three weeks later we visited him in Belleview Hospital in New York and he was in an iron lung. He’d gotten polio. At that time in the early 50s, the mothers of America who were very worried about their children, started what they called the Mothers March of Dimes. I watched over the last 50 years the March of Dimes raise money for the eradication of first polio, which happened. We don’t see polio anymore because they funded research for Jonas Salk and move them to birth defects and now they’re working on prematurity. I’ve watched the parents of a seven year old girl who had juvenile diabetes in 1970, start a center here in Colorado called the Barbara Davis Center which is solely been focused on research and the care of children with Type I diabetes and the enormous success they’ve had. Everywhere you look there is literally a nonprofit organization that raises money for every adult and pediatric disease and every organ of the body. We have the American Heart Association, lung association, liver association, I mean you can go through all of them. There are hundreds and hundreds and when you look around there is nothing in child abuse and because we have dealt with abuse primarily as a social and legal issue, that’s actually because in the 1960s and 70s, physicians and other health practitioners were not interested in the area. They thought it was a social problem. When Henry presented his paper to 1000 pediatricians in 1961, there were no questions and they all walked out of the room silently and thought ‘not in my practice. It doesn’t happen here. That’s just poor people or other people.’ And it’s not, and one of the reasons I know it’s not is because in the 1970s we re-discovered sexual abuse and sexual abuse is clearly an issue that crosses all lines and that’s in the 80s what Lori experienced and what Lori and I realized, and she I’m sure said this in her interview, if the person who kidnapped and abused her had gotten the help when he was abused that she got when she was a three year old, she wouldn’t have needed the help she got. And from a pediatric perspective because I spent a lot of time walking around newborn nurseries and taking care of newborn babies who are unbelievably cute and innocent but as you walk around that nursery you kind of wonder to yourself what this little boy or little girl’s trajectory going to be? Are they working towards what we saw in the inauguration of our new President, with a 20 year old young woman who is the new Poet Laureate and who is an amazing individual, or are they going to be someone like the individuals who rushed our Capitol and are angry and violent? There’s probably some genetic predisposition and it depends on how they’re cared for and how they learn to care for others. So I have no idea what your question was now and I’m just sort of wandering but we realize there was no such thing for abuse because everyone thinks it’s someone else’s problem and the other thing is there has been so much shame and stigma that those who’ve been abused, the vast majority of whom will survive it and do well or even transcend it the way Lori did, never talk about it. When I was growing up in the 1950s I had an aunt with breast cancer. Nobody ever talked about it because there was shame involved. How could you talk about a woman’s breast with cancer in it in the 1950s? It wasn’t done and the family never said a word. Similarly I had an individual in my extended family who sexually abused the girls in our extended family and nobody ever talked about it. It wasn’t until the 1980s when I was doing this work that I realized I had a grandparent who was an abuser. Nobody talked about it. Not the young women in my family who were abused by him, not my uncles and aunts and parents who knew about it but never talked about it. So the burden of all this fell on the child who’s victimized and that’s just not right. How they survive it is through a lot of help and support and by talking about it. That’s why we decided that what we’re looking for with EndCAN are the millions of adults who experienced abuse and never talked about it and are doing well and would like but clearly have periods of pain or flashbacks or other things, and we just need to bring this out so we can address it from the beginning.
>> Dayna: You definitely answered my next question which was what do we need to do as a society to change my perspective about child abuse and neglect so next question again.
>> Dick: Well we need to talk about it and the most important group to focus on because they’ve been ignored – and all people are important to focus on – but it’s the boys. The boys between the ages of 3-10 that something happens to either within the family but more often outside the family and they’re abused physically, sexually, emotionally, or maybe all of them and they never talk about it. The woman’s movement of the 1970s had a large impact of bringing sexual abuse, primarily against women, into the open but even now we see men in their 40s, 50s or 60s who were abused in the Scouts or in churches or on teams or in other settings but never talked about it. They may have some alcoholism, they may have periods of depression. Something happens to boys early on that nobody notices and they don’t talk about. That’s our opportunity in intervention to really make a difference and improve the outcomes for boys and the other boys and women that they will later abuse.
>> Dayna: That was exactly my next question I had for you.
>> Dick: I wish you’d sent me the questions so I could know them in advance
>> Dayna: I sent them to Lyndsay.
>> Dick: Oh really? She never passed them onto me so I’m doing this cold
>> Dayna: That’s okay
>> Dick: Actually she did pass them on to me. I’ll have to go back and read it but I think I’m doing okay.
>> Dayna: You’re doing great. The next question I had for you is, research has suggested that most abusers were once abused him or herself. What do you think we need to know and to do to change this for the better?
>> Dick: Well first while it’s true that all of the abusers we’ve ever seen have experienced abuse in their childhood, the public believes and I think it contributes to the silence, there’s a belief that if you were abused then you’ll be an abuser and that’s absolutely not true. The majority of abused children will not grow up to be an abuser. They will do okay. The reasons for that are in part because there are usually other adults in their environment – grandparents, aunts, uncles, teachers, ministers friends, neighbors – recognize what’s going on and give them the message that what’s happening to you is not your fault. What’s happening to you shouldn’t be happening and if you need me to help and protect you then I’ll do that but you don’t need to grow up like that. The abused child who believes that they are a bad child and the beatings that a parent or step-parent did was what they needed to do to make them a good kid, are likely to repeat the cycle. If you believe that this is the way to love and care for children you’ll tend to repeat the cycle. The psychiatrist who worked with Henry Kempe for many years and who I worked with, was a man named Brandt Steele. He described abuse like a cancer of the soul. It’s treatable like most cancers but for some people it’s not. It’s malignant and those are the ones that will repeat the cycle. Others, it won’t happen. Brandt also said, “if you don’t understand someone’s behavior, you don’t have enough history.” So when someone is acting out, and you don’t understand why they’re behaving the way they are, instead of hitting them or screaming at them telling them to stop, you need to sit down and have a conversation and explain to them what’s going on. It was good advice.
>> Dayna: I love that, cancer for the soul. I’ve never heard of that and it’s definitely something I’m going to highlight with this interview and I think it’s something a lot of people can relate to. It’s a perspective that a lot of people don’t think of when they think of abuse and trauma.
>> Dick: Because we viewed it in such a way for so long, the instinct is to punish and punish the abuser instead of sitting down and finding out how. The truth is back in the 1960s, 90% of the families who Henry and Brandt and the large team they had treated when they saw an abused child, never abused the child again and the child was back with the family within a year and if not the child was placed with someone else for a while. The problem with our child protection system in the United States and to a certain extent in Canada, there’s no treatment. There’s just identifying cases, labeling people and there’s no real treatment for the child or the family and there’s no long term follow-up to see if what we did as a system when we reported them and they were taken on by child welfare, there’s no follow up to know if whether that actually helped the family. That’s another thing we hope with our Foundation is that we can begin to help the field that’s working with abused children and their families learn how to be honest about our mistakes and ask people how the experience is working with us. Did we actually make things better or did we make it worse, and how can we make things better.
>> Dayna: I think that point about intervention is so important and the follow-up afterwards can really make a difference in someone’s life. The next question I have is why do think funding for research to help us understand the long-term impacts of maltreatment and current interventions are so limited? What do you think needs to be done to change this?
>> Dick: Well we believe the model has been in place for 50 years. The United States, with the National Institute of Health, together with its medical research council, I don’t know the exact name but there is a research council. Research has been funded for 50 years on practically every affliction that’s been viewed as a health affliction and things get better. Intuitively, looking at what happens and the struggle our child welfare colleagues have in trying to meet the mandate that we give them in trying to investigate and help every family we report to them, is not working. So we have to have different approaches. There has been research. I don’t want to suggest that the field is exactly where it was back in 1960. It isn’t. We now know much more about recognizing abuse than before. There is research going on but it’s mostly self-funded. There’s some wonderful research going on about prevention. We know that if we provide someone like a public health nurse home visitor to a pregnant woman and she stays with her for the first two years of the baby’s life, over the course of that mother and baby’s life both will do much better and there won’t be any abuse in 87% of the cases. So there are interventions that work. This social mindset instead of the health mindset, we create a prevention program and that is a nonprofit/ NGO type organization that we have to raise money to sustain. If we know providing home visitation support is enormously helpful, why isn’t that part of our health system? This person can go get their knee replaced, this person needs a home visitor when you’re four months pregnant. It’s not so easy to go through pregnancy particularly if you yourself have experienced trauma in your childhood. It’s critical. I know as a pediatrician there are no new mothers and fathers who can’t use a lot of help. Now for most families that’s their own parents but for a lot of families, there parents are a part of the problem, not a part of the solution. They’re the ones we need as a health system and as neighbors to gather around and support. So we have to have more research to understand the impact and to effectively treat people and to help them bring it out into the open.
>> Dayna: I 100% agree. Preventing it by way of informing the parents and future parents so if they have experienced abuse or trauma they have a way to heal that and it’s stopping that intergenerational trauma from being passed down.
>> Dick: Right. And it starts with being able to talk about it.
>> Dayna: It really does.
>> Dick: Which is why we use the phrase Louder Than Silence
>> Dayna: That’s very true. The last question I have for you is why do think it’s so important to get more funding for pediatric subspecialists to focus on childhood abuse? What do you think they subspecialists can do to help break this cycle?
>> Dick: Well that’s interesting because I should tell you that 15 years ago when the proposal to have a subspecialist in pediatric abuse was put up before the American Board of Pediatrics, I opposed it. I thought it was a bad idea because there was no NIH research or training money to support the subspecialty. It passed anyway and it’s here and we have hundreds of child abuse pediatricians and many of them are my colleagues. What I’ve noticed is most of their work, 80-90% of their work, are done for prosecutors and the courts and for child welfare to have expert testimony. That’s not my vision of what my subspecialty in child abuse should look like. It should do that, and when I did child abuse in the 80s I testified in court a lot. I testified in the first criminal prosecution of a child abuse death in Colorado here in 1981 but it’s got to be more than that. It has to include how we engage our behavioral health colleagues, the psychologists and psychiatrists and social workers. How do we engage community workers and family support centers and others in creating an environment that can not only treat the abused children and their families so the children can be back with their families, but we can focus on prevention and there’s practically no prevention work coming out of the subspecialty and very little treatment work coming out of the subspecialty. So right now it’s all forensic. I’m hopeful that if we can first get the 5 – 10 million people to sign up with us the way they sign up with Society for the Prevention of Cruelty to Animals – and I see the sad-looking dogs in shelters every night and send $19 a month to them, or the children at St. Jude’s Hospital who need that as well, if the abuse community, those who’ve experienced it, can come together and build the advocacy group, I think NIH and the research will follow and then the subspeciality will grow and flourish but it can’t grow and flourish if it’s only source of revenue is expert testimony.
>> Dayna: Very interesting. I didn’t realize that so I hope EndCAN can do wonders in creating this community for survivors and not only just for survivors and people that have experienced it but everyone else who can help everyone else.
>> Dick: We’re only three years old. We’re just learning to walk but it’s going well. We’ve got a terrific little team. Lori is a dynamite leader for our group and we’ve got a wonderful Board of Directors that I get to Chair and maybe someday we’ll be like the March of Dimes and everybody will understand it.
>> Dayna: That will be amazing one day.
>>Lori: I want to thank each of you again for joining us today and listening in. If you or someone you know is being abused, please call 1-800-4-A-CHILD. To learn more about EndCAN, visit www.endcan.org or find us on all social media platforms. Join us in being Louder than Silence and being a part of the change. Please leave a comment, like our podcast, or share with your friends. The more the word spreads, the more of a collective impact we can have. If you have a question or you know someone who would want to be a guest on our podcast, please contact firstname.lastname@example.org. Thanks again, and have a great day.