Pediatrician Dr. Vincent Fontana discusses child care.
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GUEST: Dr. Vincent Fontana
I’m Richard Heffner, our host on THE OPEN MIND. As puzzled and as distraught as every other feeling American by the statistics of child abuse in our nation. Now perhaps when he was here on THE OPEN MIND years and years ago, neither the intensity nor the extent of the child abuse problem was, as yet, fully recognized, and perhaps that was a major reason why then we had not yet mobilized our national resources to deal with it. But even now we haven’t, and now the statistics of child abuse are thrust upon us daily, we can’t avoid them, we have to be aware of them. And yet the problem grows. So that I have many questions for my guest, Dr. Vincent J. Fontana, Medical Director and Pediatrician-in-Chief of the New York Foundling Hospital Center for Parent and Child Development and Chairman of New York City’s Taskforce on Child Abuse and Neglect under Mayors Lindsay, Beame and Koch.
Now, Dr. Fontana is a world authority on the plight of the mal-treated child and I want to begin by asking him if the abusive sins of parents are visited upon their children who, in turn, become abusive parents themselves, whose sins are visited upon their children, how can we ever even hope to break this always-widening circle and thus diminish its deadly dimensions? Dr. Fontana?
Fontana: Richard, the problem of child abuse in this country is increasing at the rate of fifteen to twenty percent each year, which means that more and more children have been dying as a result of abuse/neglect, but more importantly, they’re being damaged so that they provide the kinds of citizen in our community that perpetuate the crime and violence. We are losing, in this country at the present time, 4,000 to 5,000 children every year that die as a result of abuse/neglect. Four to five thousand. In this city, New York City alone, we lose an average of two children a week, that die of abuse/neglect. As a pediatrician, I don’t know of any disease, infection that causes the number of deaths that child abuse/neglect causes, and yet, we as a society, have not really been able to confront the problem. We turn our backs on these abused children, we don’t confront the problem simply because child abuse is not our problem, it’s a family problem: “I can’t interfere with a neighbor’s, friend’s or relative’s” that are abusing and neglecting their children, and that kind of attitude has perpetuated and increased the problem of child abuse and neglect in this country.
Heffner: Well, suppose we focused on that part of the attitude that said, “I can’t interfere, I can’t invade the privacy of my neighbor”. How do you relate to that question?
Fontana: Child abuse is everybody’s problem, for a number of reasons. Child abuse kills in three ways – it kills the child, it kills the family and it kills society. And if for no other reason but a selfish motive, forgetting the fact that the child is being battered or abuse/neglected by a family , or a parent, this child, if it survives and grows up, for the most part, will become the perpetrator of the crime and violence. The runaways, the throwaways, the kicked out kids, the prostitute…young prostitutes, those on drugs that are now assaulting, murdering and robbing, have come out of families in which they suffered abuse and neglect. Physical abuse, emotional abuse, sexual abuse, and so we go back again. We’d say, “Why should I become involved?”. You have to become involved simply because even if you’re not abusing your child, your children and your grandchildren are growing up into a society that is going to be filled with crime and violence. If we think crime and violence in the eighties has been bad, if we allow this violence generating from family to family and from generation to generation to go on, the 1990s is going to be filled with a society of very hollow young men and women.
Heffner: But, you know, we’re not talking about an idea alone. You’re the first one to say that. We’re talking about this very real situation in which first these children are being mal-treated. In practical terms, how does one accept what you just said, set aside that notion of…well, it’s not that it’s their problem, but it’s their private family. How do you go about becoming involved, as you think we must?
Fontana: You…we must become involved, and we must become our own social workers, so to speak, Richard. In other words, if we know of a child who’s being abused or neglected or battered, such as Lisa Steinberg, child in New York City which was a terrible tragedy, we as neighbors and friends and relatives have a responsibility to intervene, to save that child’s life. And by intervention I don’t mean going down and being like a gangbuster and saying “Who did it? Why did you do it?”, and breaking down a door. We have to intervene, saying “You know, I think you’re having problems. I think you need help. There are treatment and prevention programs in every community in this country that can stretch out a helping hand. We’re not going to point a finger, but for heaven’s sake, get help. For two reasons: to save yourself, as well as to save your child”. If we go along with that attitude, of intervention. In other words, trying to help each other, neighbors, friends and relatives, then, I think, we might come closer to winning this battle against child abuse. As it is, the Lisa Steinberg case is a perfect example. Social workers went in because they were called in, as a child abuse case. The police went in because there was domestic violence. The teachers noted that the child was coming to school poorly dressed and looked as though she had a number of bruises. And yet the police didn’t speak to the social workers, the social workers didn’t speak to the teachers, and the neighbors, who knew about what was going on, didn’t speak to anyone of those professionals, and so we have a child who dies, unnecessarily, and we see this throughout the country, simply because the people that are dealing with children in families, in this country, are not talking to each other. In other words, there is little or no coordination, cooperation and communication between the agencies that are responsible for children. Namely, schools, hospitals, mental hygiene clinics where they see the parents, drug rehabilitation programs, the Family Court, and last but not least, the community. And then you expect the child protective agency in any part of this country to protect a child. It is impossible today simply because they are overloaded, and some of them almost paralyzed, so that children continue to die at an unbelievable rate, simply because the child protective agency in a community is unable to protect that particular child.
Heffner: Now you recognized this phenomenon a long, long time ago, and I’ll go back and read the prescription you offered for it. What happened?
Fontana: Nothing’s changed. In the book that I wrote SOMEWHERE A CHILD IS CRYING I brought out the fact that children will continue to die just as long as we are not speaking to each other. Unless we have communication, coordination, and cooperation between the agencies that I’ve mentioned, people talking to people, the children that are dying in this city and throughout the country are not isolated in the wilderness or in the jungle. They’re in a large city, and yet there are neighbors all over the place and still the child dies simply because people have said, and on television I heard it recently, when a child was found dead, that the neighbors said, “Well, it’s not my business. I have a hard time taking care of my own kids. Another neighbor said, “I know of two other families that are abusing their kids, but I’m not going to tell you where they are”. As long as that attitude persists, children will continue to die.
Heffner: Yet I know you well enough to know that you’re an extremely “up”, optimistic person. How can you be, if what you describe now is worse than what you described a decade and more ago?
Fontana: I’m, I’m sort of pessimistic, but at the same time I have hopes that our national leaders and our state and city leaders will recognize the fact that here in New York City and throughout the country, we’re talking about the prevention of crime and violence, we’re talking about preventing this drug addiction that has taken over our country, and yet they fail to recognize the fact that our prison system is filled with kids that learned violence within their own homes. These kids, murderers, those that rape, those that rob, that are serving time, had been abused/neglected. Almost 90% of the murderers that are in our prison system had been abused or battered by their own. Dillinger, Oswald, Sirhan Sirhan. So that what we’re doing when we talk about prevention of crime and violence…these politicians are not talking about child abuse, and I say if you’re going to talk about the prevention of crime and violence, and not bring in child abuse, it’s like putting the cart before the horse. You’ve got to go to the root causes, and what they’re doing, really, throughout this country, is treating the symptoms of a social disease, rather than finding the causes of the disease, and in medicine, you know, Richard, if you treat a patient for the symptoms of a disease without finding the cause…what happens to the patient? He dies.
Heffner: Okay, but that takes me back to the first question that I put to you. Given what you have described, the sins of the parents are visited upon the children, who become parents themselves and pass on the abusive syndrome. What gives us the right to have any hope at all if the problem has been growing and there are more and more potential abusers in our nation?
Fontana: I think there is hope, Richard, if we re-establish our priorities. In this country we talk about children being the most important natural resource we have. But, you know, if you look in the newspapers and you go around questioning people, we’re more concerned about saving the environment that we are about saving children. Until we establish a priority that children, indeed, are important…just because they have no vote, they have no voice, they have no rights, we just don’t bother with them, and when you start putting money into, into things about social problems, old people and young people are at the end of the spectrum. We can save this society, we can save this country, by re-establishing the fact that children are prioritized. If we don’t do that, children today are not being prioritized.
Heffner: Yes, but you know, you say “if we re-establish” that notion, and I really want to press you on that. Do you mean “re-establish” or do you mean “establish”? We’ve always prided ourselves, we’ve talked about, we’ve given lip-service to the notion of being a child centered, child focused country. But have we, indeed?
Fontana: No, we haven’t. It’s been national rhetoric. When I say “re-establish”, I truly mean “establish”.
Fontana: People have been talking about prioritizing children but they really haven’t done it, and I’d like to come back to another…the community, the people, individuals like ourselves are not able to identify with an abused child. They’ll identify with a child who has cerebral palsy, or a child who had polio, or a child who’s got leukemia, or dying of cancer. But for some reason, Rich, we’re not able to identify with an abused child, and I believe the reason for that is that God is responsible, perhaps for leukemia and cancer and cerebral palsy, but child abuse is a human frailty, and I think in all of us there is something of a child abuser and we don’t want to confront that.
Heffner: You know, on a parallel program at the time of the Lisa Steinberg trial, Ted Shapiro, a psychiatrist was here and mentioned that. And that was such an intriguing notion that stimulated response from so many people. You mention the same thing. You really think there is that spark, if that’s the word.
Fontana: We, we call, we call it an inhuman disease. It’s not an inhuman disease, it’s a human disease. It’s a human frailty that during times of violence, during times of poverty, during times of the fact that they feel hopeless, during the fact that they’re under stressful situations of living, parents strike out at those that are closest to them, namely the child, who often times they love, and so…well, let’s just relate it to just every day goings-on, I mean, if you have an argument with your wife, or your girlfriend or you decide to become upset and terribly upset, you say things that you’re sorry for, you may even do things that you’re sorry for, but you do it to someone who you love very much, and many of these parents, as you mentioned before, many of these parents that we have treated in our programs, who have abused their children, had been abused themselves by their own parents physically, sexually, emotionally, which you know, you don’t have to beat down at a kid with a belt buckle or a fist to abuse. There’s the insidious kind of an abuse which is damaging more children in this country than even physical abuse, and that’s emotional abuse. The verbal abuse of a child. “You’re no good, you never were any good, you’re a whore, you’re a prostitute. Get away from me, I can’t stand you”. This constant rejection of a child which a parent might not even recognize as being abuse, is hurting that child inside. It doesn’t show black and blue marks, but when I asked a child, “You know what the difference between emotional or verbal abuse and physical abuse is?”, this kid said to me, “well, physical abuse, you’ve got the black and blue marks, but verbal abuse and emotional abuse hurts you inside and you can’t show the black and blue marks”. And so we’re destroying our generation of young kids by the fact that parents, for one reason or another, are not spending enough time with them, but more importantly, are not giving them the things that they need for normal growth and development, which is caring, love, affection.
Heffner: Which the parents don’t seemingly have for themselves. Which is a point…
Fontana: Well, the terrible part, Richard, is the fact that the parents that are abusing their kids, and are practicing abuse in the name of discipline, don’t recognize this as being abuse because often times they, themselves, were raised that way. In other words, I have parents say, “You know, spare the belt and spoil the child”. Well, that was alright thirty years ago and forty years ago. Today if you use the belt, you’re going to spoil the child.
Heffner: You know you wrote, back in..oh, a decade and more ago…
Fontana: ; (Laughter)
Heffner: You don’t mind my quoting you…come on. You wrote, “We must support programs”…this was your RX…you’re a medical doctor, you wrote a prescription…”we must support programs that will eliminate poverty”, and you weren’t talking about things in general in America, you were talking about our same topic, the mal-treatment of children. “We must make the poor self-sufficient, support educational programs for parenting both in the school system and in the community, and support a type of national health insurance that will guarantee the newborn a life of normality and give parents them means to provide their children with a quality of life that will encourage love, affection, and security, rather than hatred, neglect, and abuse”. Amen. But…
Fontana: A voice in the wilderness that has not been heard.
Heffner: Then I wouldn’t expect you ever to shrug your shoulders and turn your back on this.
Fontana: Oh, no, I’m angry. I’m angry. You’ve read that and that was written perhaps about twenty years ago. I’m angry that our nation has not recognized the plight of the abused and battered child. In spite of everything we’ve done…we’ve got child abuse laws in every state, we have a national center for the prevention of abuse, we have millions of dollars being thrown into treatment and prevention programs, and yet the things that you just mentioned, that will certainly bring us closer to winning this war against child abuse have not been implemented. Our national government, our state government, our city government is guilty of not implementing something that would save children’s lives in this country.
Heffner: Dr. Fontana, what does that tell us about us?
Fontana: Tells us that as a nation we’re probably going downhill real fast because the children in our society are going to be the future of our society and if we don’t salvage them and preserve them, we’re not going to have a society.
Heffner: Are other people…
Fontana: We have to recognize that fact and I don’t think we’re recognizing that. The rhetoric, the national rhetoric is sickening. You know, “we care about our kids. They are the most important natural resource we have. They are our future”, but we’re not doing anything to preserve them. We’re more concerned about preserving the environment, as I said before than we are preserving children.
Heffner: Do you..are you suggesting that perhaps we can’t do both?
Fontana: I’m suggesting that we should preserve the environment so that we can also preserve our children for the future because they’re the ones that are going to be the lawyers of the future, the physicians of the future, the social workers of the future, the broadcasters of the future…whatever, and if we don’t give them the necessary environment to grow up to be responsible citizens, what have we?
Heffner: Okay, what does it take? Dollars?
Fontana: No, it doesn’t take dollars. It takes caring, it takes caring on your part, my part and every other individual citizen in this country to care, not only about their own children, but to care about other people’s children.
Heffner: Yes, but Dr. Fontana, the things that I read here, your prescription of…prescription that you wrote twenty years ago, that has not been followed, nobody filled tha prescription…it involves the considerable expenditure of money and why beat around the bush? Why not say “Yes, we have to tax ourselves to get those dollars”?
Fontana: Because all the money in the world, Richard, will not solve our problems unless the people that are given that money use it in such a way that it will certainly save children’s lives. A lot of the money that’s being utilized today in programs is going right down the tubes because it’s not doing the thing I think it should be doing for children and families.
Heffner: Okay, now that’s that’s really what I want to ask you because it’s one thing to say the money has to be used the right way, it’s another thing to say “First we have to find those dollars and where are we going to find them? We’re going to find them inside of our pocketbooks, just as you want to find the motivation inside of our hearts.
Fontana: The environmentalists haven’t had any problem finding money, and they’ve done a fantastic job because they have a lobby that is fantastic. We don’t have that kind of lobby, and therefore, we don’t have people talking for children except perhaps a few child advocates…a Dr. Fontana here, or a Dr. Helfer there, or whatever. But we don’t have the kind of lobby that we need for children.
Heffner: It’s not a sexy enough subject?
Fontana: Not sexy enough subject…they don’t vote, they don’t voice, they can’t carry big signs around saying “Save me, save me, save me” and parents are too busy to do it for them.
Heffner: Yes, but now what about this question that you raise and I think it’s a very important one, whether the monies that are available are being used appropriately in the right way.
Fontana: There’s, there’s…there are millions and millions and billions and billions of dollars being poured into programs which I think are not serving children the way they should, as I mentioned earlier.
Heffner: Like what?
Fontana: I think that we should…well, these social programs in neighborhoods. Unless you get a program in a neighborhood which is going to have the agencies responsible for caring for that child and families working together and talking to each other, as I said earlier, “coordinating, cooperating, communication”, that program isn’t going to work, and we found in our fatality studies that the reason the kids died was the result that information that was known to one agency was not shared with another agency. So you can have all the money in the world into a neighborhood program for one child or one family, but if that one child, one family isn’t given the absolute human support systems that it needs for survival, it’s not going to work.
Heffner: Okay, let’s assume, even now a certain level of financial support for the variety of the programs we’re talking about. Monies in the schools, monies in social work departments, etc. Why have we not done the coordination?
Fontana: Because the bureaucrats have been in place for hundreds of years, and many bureaucrats that are in their positions will say, “Just leave things as they are” because that’s the way bureaucrats work, and even Mayors of the city, or Governors can’t break through that bureaucracy. The bureaucracy now is keeping us from going forward simply because…and I’ve had this experience in New York City whereby I have indicated to the Mayor and indicated to the Commissioners that these programs will work if we do such, such and such. But “no, let’s just leave it be, we’re doing it, it’s working”. But it isn’t working because they have not recognized the fact that an agency, a child protective agency, which is supposed to protect children is not protecting children and is not doing its job simply because what worked in the sixties and seventies is no longer working in the eighties and they refuse to change. That’s where I think we have our block. That’s where the barrier comes in. So that the bureaucrats, by the way, that are put into places such as child protective agencies have had not training in child welfare, for the most part. They haven’t been trained in child abuse/neglect. We have to train them, we have to educate them and before you know it, I’ve been working for Lindsay and Beame and Koch, and I go through Commissioners. The average lifespan of a commissioner is about two and a half years. How much can he learn in two and a half years, and then once you’ve developed a relationship or a liason and he’s beginning to recognize the fact that you have credibility, then he leaves, and so that’s the sort of thing I’ve been going through and my colleagues have been going through for the last two decades.
Heffner: Now, we know that there are such things as God Committees in hospitals, committees that decide who lives, who doesn’t live, upon whom we spend our limited resources. Let’s make you Chairman of the Board. What would you do?
Fontana: Well, first of all, as Chairman of the Board of a hospital…
Heffner: No, I don’t just mean of a hospital. Let me give you, for the moments that we have left on this program, the ability to say, “We’re going to do this and we’re going to do this and we’re going to do that”. What do we have to do?
Fontana: I would first of all search out throughout this country people who have been involved in child welfare and are experts in the field of prevention and treatment to prevent child abuse and neglect. There are a lot of these people throughout the country. Secondly, I would provide programs which would certainly bring out the communication, coordination, cooperation which I think is essential, which is a multi-disciplinary approach so that a parent and child will get the benefits of the psychiatrist, the psychologist, a social worker, the physician, and the neighborhood, whatever is necessary to provide that family with the stability it needs with human support systems. We have not done that. A parent today has to go here to get this, and has to go here to get this. Before you know it that parent says, “I’m too tired. I don’t have the time to go to these places”. We have to have community programs, multi-disciplinary approach, team efforts so that a parent and a child will feel very comfortable in getting all the services, whether it’s housing, whether it’s welfare, whether it’s drug addiction, whether it’s child support, whether it’s child care. Whatever it is, it has to be in one area where that mother or that father or that parent will have the convenience of saying “I think people do care about me now because now they’re not sending me there, here and everywhere. I can get my stuff done here and my child will benefit”. So the other things I would do are what I mentioned twenty years ago which hasn’t been done because children have not been priority. I would say it’s essential that we do it. It’s as equally important that we do this…for instance, the battle against AIDS. We’re losing people, but they forget the fact that child abuse with its, with its AIDS coming in and crack coming in, we’re losing children, we’re losing families and the cost to society, besides losing lives, is perhaps even more so than the AIDS epidemic that we’re so concerned about which we should be concerned about.
Heffner: You know, it’s interesting. You mentioned AIDS and you raise…make…help me raise a point that, that I think is important. We are trying to educate people now to the phenomenon, to the threat, to the causes, nature of AIDS. Can we do so in the area of child abuse? Is it subject to education in the same way?
Fontana: I think, thanks to people like yourself, in the past twenty-five years, we’ve had TV, we’ve had radio, we’ve had media. The people out there know what child abuse is all about. It’s almost a household world at this point. We still have to confront the issue. We still have to find solutions to the problems. They’re multi-disciplinary problems. We have to find solutions to them, and we will not save children’s lives in this country until we prioritize children and poverty as important. It’s not the cause of child abuse. There are a multitude of other things that are happening in our society, such as teenage pregnancies, drugs, alcohol, divorces, separation, all feeding into child abuse. These are the social problems in the midst of which we’re living to which we must find solutions.
Heffner: You say, interestingly enough, that poverty is not the cause. I’m sure you would say that being without resources makes one more prone, but it’s interesting to make the point that you do, that child abuse seems to occur, and you mentioned the Steinberg case, in middle class and perhaps even upper class.
Fontana: And that’s a sad commentary because child abuse occurs in low income, middle income and upper income. The low income people surface. They’re seen in our clinics, they’re seen in our emergency rooms, they’re seen on our city streets. But the middle income and the upper income, it’s hidden. A pediatrician sees a kid with a broken arm, Mom says he fell off the bicycle. Actually it’s the alcoholic father. We have verbal abuse and psychological abuse. Kids go off to college, prep school. They’re forgotten about. These are the kids that become the forgotten children of our society. They’re the throwaways, the runaways, the kicked-out kids. They’re middle income, they’re the rung on drugs, the young male prostitutes and female prostitutes. They come from middle income, and this crime and violence which is all over us now throughout the society with the drugs. And everything else that’s bad comes from the fact that children suffered in their early childhood, as a result of abuse/neglect are now declaring open war on society.
Heffner: Do you want us… we have a half minute left…you said something earlier about being social workers ourselves. I think people who watch want to know really what to do. To what extent did you mean that?
Fontana: I, I think the bottom line is caring. Caring about what’s happening to our society, caring about what’s happening to our children, caring what’s happening to our neighbors, friends, relatives. We have to establish our own bailouts. The grandparents have disappeared from the scene. The aunts and uncles have disappeared from the scene. We now…community, neighbors, friends and relatives, have to establish bailouts for those that are in need.
Heffner: You think the community can become a substitute for the family?
Fontana: If the community does not become a substitute for the family, and we don’t have an extended family within the community that we have provided, society will suffer even more than it’s suffering today.
Heffner: Dr. Vincent Fontana, thank you so much for joining me today. I hope the next time you come back, before another decade, you have better news for us.
Fontana: Thank you, Richard.
Heffner: And thanks, too, to you in the audience. I hope you’ll join us again next time. And if you care to share your thoughts about today’s program, today’s provocative guest, and our theme, please write to THE OPEN MIND, P.O. Box 7977, FDR Station, New York, NY 10150. For transcripts send $2.00 in check or money order. Meanwhile, as another old friend used to say, “Good night and good luck”.
Continuing production of this series has generously been made possible by grants from: the Rosalind P. Walter Foundation; the M. Weiner Foundation of New Jersey; The Mediators and Richard and Gloria Manney; The Edythe and Dean Dowling Foundation; the Lawrence A. Wien Foundation; the New York Times Company Foundation; and, from the corporate community, Mutual of America.