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Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. 2007 May 1; 57(538): 416.
PMCID: PMC2047034

A farewell to heart sink?


Emotional abuse is a concept that lays itself wide open to — well — abuse. But perhaps it can really be put very simply. To have experienced emotional abuse A must have heard or interpreted words like these early on in life:

‘You're not the way I want you to be.’

‘It's your own fault.’

‘Everybody else knows how.’

‘If you really wanted to, you'd do it for me.’

‘I'd be a good parent (teacher) if it weren't for a child like you.’

Did anyone in A's life really say these words — or consciously imply them? Could they have been spoken/implied by someone unaware of their power to annihilate, someone no longer capable of hearing how they would strike a child? Someone so damaged by their own childhood that they themselves had never come to realise how such an attack would strike a child in his self-image or worth? In emotional abuse, the child's love, trust and attachment are used to warp the course of the child's development in the (un)conscious interests of the adult, who is lashing out with unresolved damage of her own.

For an 11-year-old boy, Russell already has an impressive accumulation of notes. A very premature baby, his parents were worried that he might be a slow learner; but by the time he started school, he seemed to be of average ability, if a bit small for his age. His mother — or sometimes his grandmother, who lives with the family—turns up with him at the surgery every few weeks, with suspected ear infections, chest infections or tonsillitis; demanding antibiotics, and wondering if he ought to be taking fish oil or extra vitamins? Shouldn't he be referred to a specialist?

You get the feeling that Russell is an unsatisfactory child, who needs to be put right; and if only you were a good doctor, you'd see that he's all wrong. A child like this has to live in an atmosphere of constant criticism which amounts to emotional abuse.

Emotional abuse inevitably accompanies physical and sexual abuse and may also occur where there is:

  • Rigid ‘discipline’ at home or in school, in deference to values of past generations and unrelated to the child's real needs.
  • Harsh or intolerant religious/cultural indoctrination.
  • Excessive demand for achievement.
  • Excessive demand for conformity to questionable standards.
  • Role reversal where the child is expected to be strong or considerate or self-effacing beyond his years, for the sake of the fragile adult(s).
  • Deception surrounding adoption or parental disappearance.
  • Unpredictable and deficient parenting associated with alcoholism/drug abuse/untreated mental illness. For further examples, we need only consult our patients.

Mary is 14 years old, the eldest girl of a large family, and a great help at home; her mother says she is a little saint, the way she looks after the younger ones, making all their breakfasts before she goes to school. Her father is away a lot in his job as a drug company rep; when he is home, he often relieves his stress by going out drinking, but her mother says that Mary still adores her Daddy and won't hear a word against him. However, lately Mary has been having a lot of stomach upsets and seems to be off her food; after glimpsing her daughter in the shower, her mother is worried that she is getting dreadfully thin.

Mary's developing anorexia is telling us something about the unacknowledged problems in her family. Seeing her mother struggling with a difficult marriage and an impossible workload, Mary has found a way of fending off the demands of womanhood; she goes on being the good girl who is loved and approved of — sustaining, even if it kills her, the apparently vital illusion that all is well.

What these parents have in common is that they provide an insecure environment for the developing child, where she learns not to trust herself or others; where she is expected to strive after goals which entail giving up much of her own spontaneity and creativity to others' demands. This is likely to leave its lasting mark in depriving her of self-esteem and self-confidence, and leave her with feelings of anger and outrage she may not even be aware of. All the same, they are painfully eating away at her, and are making her feel worthless; even if she is busy establishing what appears to be a fulfiling life, with a successful career and happy family. Unknown to her, inside her, a cry has been waiting to be heard since childhood:

‘I am that I am.’

‘I love you T-H-I-S much.’

‘I know I don't give you what you want.’

‘I keep trying to because I love you.’

‘I can't help myself.’

‘I'm mad at you, I hate you.’

‘I hate myself.’

‘You made me the way I am but I can't face it that you did this terrible thing to me.’

‘When I grow up I'm going to be depressed — no — workaholic — or …’ ‘I'm going to get my own back and become a delinquent addicted paedophile serial killing suicide bombing heartsink patient — and — and — and — you'll be SORRY.’

Simple as that. King Lear said it first:

I will do such things

What they are yet I know not, but they

shall be

The terrors of the earth.

As for an example, do we need to look very far? In our own hearts?

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners