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Emotional abuse is profoundly damaging but readily overlooked. Whereas bruises and fractures often heal quickly and fully, the damage of uncorrected emotional abuse is lifelong. It compromises development of relationship-dependent areas of the brain, influences programming of neuroendocrine function, 1 2 3 and has lifelong implications for physical and mental health, including major causes of mortality. 4 5 It is relevant to children's behaviour problems, substance abuse, aggression, criminality and intergenerational parenting problems. 6 7 8 9 10 11 12 13
Physical abuse and intrafamilial sexual abuse are generally the tip of an iceberg of dysfunctional relationships: their emotional context is often their most sustaining and damaging component, 14 15 yet relatively infrequently the principle grounds for protective intervention. There is commonly delay in both recognition and action. 16 It may be self-limiting physical injury which leads to safety after years of emotional abuse on which professionals have struggled to act: such difficulties warrant consideration amongst possible contributory factors to serious failures of child protection.
Services to protect children: wrong solutions for emotional abuse?
The child protection system has been moulded by its history. Although physical, sexual and emotional abuse have been recognised over generations and across cultures, they were rediscovered in the 1960s, 70s and 90s, respectively. Legislation, guidance and practice consequently evolved around immediate, episodic, definable problems, rather than the chronic pattern characteristic of emotional abuse. Legislative landmarks have been prompted by public reaction to children's deaths and media analysis of professional shortcomings. 17 18 19 20 Emotional abuse has lagged behind physical and sexual abuse in paediatric practice and training, resource allocation and political priority. It readily slides down priority lists shaped by media attention and political pressure.
The drift of responses to service failures has been to tighten regulation and external control. Although possibly helping physical protection, this does not necessarily enhance emotional safety: by reducing opportunity for independent thought it may compromise it. Recognition and management of emotional abuse depend on detailed observation, lateral thinking, initiative and adequate freedom to work creatively, whereas regulation tends to narrow the focus. Measurable targets may be poor proxies for the overall picture, yet divert resources disproportionately: key outcomes are often difficult to measure, and manifest only years later. If time and funding are...