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When is it Neglect and When is it Something Else?

portrait of young man holds his hands over his ears not to hearLike most therapists, I regularly listen to clients who report what on the face of it seems like criminal assault, abuse or neglect of themselves or others in the family. As a mandated reporter, I am confronted with the dilemma: To report or not to report to protective services.

Ah, that indeed is a question. It is an important part of our job to protect the vulnerable. But we need to take exquisite care that in our effort to be responsive and responsible guardians of the innocent that we don’t inadvertently put a family through an investigation that is at best disruptive and at worst traumatic for all involved.

For the purpose of this article, I’m going to limit this discussion to instances of suspected neglect. The literature makes a distinction between two categories of neglect: active and passive.

Active neglect is when adult caregivers actively withhold care from their children or elderly or disabled people in their care.

Passive neglect is when caregivers are too overwhelmed, ill, burned out or impoverished to provide needed care. In both types of cases, a vulnerable person is being harmed. In both types of cases, reporting to protective services is mandatory and essential.

To those two categories, I add what I’m calling “counterfeit” neglect (with a bow to David Hingsberger who coined the term “counterfeit deviance”).

Like counterfeit money, counterfeit neglect looks like the real thing. But, on closer examination, “counterfeit” neglect is when something that at first looks like neglectful conduct on the part of caregivers is in fact behavior that is because of challenging family circumstances, family beliefs that are different from the norm, ignorance or is a self-protective response to negative experience with the “system” (a school, government agencies or government programs).

Note, please: Unlike counterfeit money, counterfeit neglect is not a result of an attempt by caregivers to deceive or manipulate others. It’s simply a look-alike.

In all cases of suspected neglect, it’s crucial that we not overreact to a situation we may not completely understand. Being too quick to report can permanently disrupt treatment, damage relationships within a family or negatively affect the willingness of the family to get the treatment or services they need.

Calm, respectful questioning can surface what is really going on in the family. If the problem isn’t neglect but the outcome of trying too hard to do too much with too little help, information or resources, we can be of enormous service to a family by supporting them in their efforts to do the best they can and to exercise their parental and/or legal rights. When appropriate, we can help them navigate the daunting service system.

Types of Counterfeit Neglect (the appearance, not the reality, of neglect): To protect privacy and confidentiality, these examples are fictionalized accounts.

Ø  Poverty: A teen at a program where we both volunteer liked to talk to me. She was always clean and neat but her clothing was tattered. She needed a haircut. She complained that her mother made them the same pasta dinners all the time. Other volunteers, well-intended middle class women, wondered if the teen’s mother should be reported to child protective services for neglect. Was the girl being neglected?

No. The family was struggling. They were doing the best they could with limited resources. They were barely able to provide the basics but they did do that. The mom was feeding her kids a diet that wasn’t creative but was adequate and she was clothing her kids from the local thrift stores. Basic is good enough – especially in a home that is a loving one.

Ø  Fear: The local senior center reported a family because their client was coming to the center with bad body odor. Although she lives with her daughter, the elderly woman is legally competent. When the center’s director asked why her mother wasn’t clean, her daughter explained that her mother didn’t like to bathe and would throw things at her if she tried to get her to do it anyway.

Her mother is a lot stronger than she looks! She was afraid her mother would hurt her if she insisted.

This is not reportable to protective services. Although the daughter is providing care, she is not a “caregiver” of a competent adult. Competent adults have the right to make poor choices – like not taking regular showers. (If the mother was not legally competent, it would be reportable).

In this case, the central issue is helping the daughter (who is otherwise providing fine care) manage her mother when she becomes aggressive.

Ø  Family Values: One family I know home-schools their kids and only lets them play with children who go to the same church. They believe it important to shelter their children from beliefs contrary to their own while they are young.

“I don’t want their heads filled with different ideas in school”, the father told me. “When they are older, they can make up their own minds.” Are they being neglectful by limiting their children’s social involvement to people like themselves? I don’t think so. Lack of diversity in kids’ playmates isn’t neglect (although it may be unfortunate). These parents are exercising their right to parent in a way that is true to their values.

Ø  Lack of information: One cold winter day, a neighbor of a rural family (single mom with disabled daughter) called the agency where I worked because she was concerned. When she had gone over for a visit that morning, the heat in the home was set to 50. The family was coping with the cold by wearing layers of clothing and huddling under blankets.

When a social worker went to see the family, she found that circumstances weren’t dire enough to report neglect of the disabled girl. The home was cold but not freezing. They did have a woodstove in one room and sufficient wood stacked out back to keep that room reasonably warm. Why was the heat set so low? The mom had become so discouraged in her attempts to navigate getting fuel assistance that she had given up. She hadn’t known who to call for help.

Ø  Negative experiences with the system: A family was reported to protective services sometime in the past. Although the case was unsubstantiated and social workers tried to be helpful, the family is now scared to death that the person in their care will be removed if they let anyone who represents the “system” in their door. They therefore continue to live more marginally than they would if they accepted more services. It is now up to the helpers (case workers, teachers, doctors, etc.) to work hard to reassure them and encourage them to accept the help available.

Exhaustion: An exhausted parent might fall asleep when he or she should be watching their kids. An overwhelmed parent might sit down and cry instead of making a hot meal for dinner. A frustrated caregiver of a disabled adult might yell something inappropriate. All the therapist hears (perhaps from an angry relative or a well intended neighbor) is that Mom or Dad didn’t supervise the kids or make dinner or that a caregiver is mean.

There is a fundamental difference between someone who is neglectful and someone who dropped the ball once or twice. Let’s remember that parents and caregivers are human, often doing superhuman work. A mistake where no appreciable harm was done can be the wake-up call an adult needs to do better self-care while taking care of others. Our job is to support those efforts.

Related article:  Neglect: The Quieter Abuse

When is it Neglect and When is it Something Else?

Marie Hartwell-Walker, EdD

Marie Hartwell-Walker, Ed.D. is an author, licensed psychologist, and a marriage and family therapist who has been in practice for more than 35 years. She is a regular contributor to Psych Central and one of the therapists who answer questions at Ask the Therapist.

 

APA Reference
Hartwell-Walker, M. (2016). When is it Neglect and When is it Something Else?. Psych Central. Retrieved on November 11, 2018, from https://pro.psychcentral.com/when-is-it-neglect-and-when-is-it-something-else/

 

Scientifically Reviewed
Last updated: 28 Nov 2016
Last reviewed: By John M. Grohol, Psy.D. on 28 Nov 2016
Published on PsychCentral.com. All rights reserved.