How we can end the cycle of bullying
BACK TO SCHOOL, and in my pediatric practice worries about bullying reappear. Recently one 10-year-old told me of his fears. Last year, despite many discussions with school personnel, he had not felt protected from a boy who repeatedly tormented him. The bully is also my patient. He was physically abused through much of his early life. I knew that until this other boy could get meaningful help, there was little the school could do to stop his behavior.
While discussions of bullying usually focus on children, anyone who has worked in an organization knows that these behaviors, if not addressed, may continue into adulthood. At worst, bullying leads to violent, criminal behavior. A recent study in the Archives of General Psychiatry of 5,000 children in Finland found that both bullies and their victims were at increased risk of needing psychiatric treatment in their teens or 20s. We need to think carefully about the origins of this problem, and to devote significant resources to prevention.
Bullying is a symptom. People have difficulty managing their aggression. This symptom can start very young. Toddlers who are just learning to control their healthy aggressive feelings may grow up in environments where the adults in their lives are not able to help them with this task.
Assertiveness, a quality generally considered to be a positive one, actually has a similar meaning, but looks different in a 2-year-old. Lacking the verbal skills to express intense emotion, Johnny, wanting the red truck another child grabbed out of his hands, may not have a calm discussion, but instead take the truck and whack the other child on the head. Parents clearly have the responsibility to teach a child that such behavior is unacceptable. But in order to learn to manage his aggression as he grows up, a child needs to know that his feelings are acceptable, just the behavior is not. He needs help learning how to understand and contain strong emotions.
If a parent has experienced violence in her past, she may misinterpret a child’s healthy aggression. When Johnny whacks another kid, or hits his mother, she may experience a surge of stress and even rage. These feelings have nothing to do with Johnny, but make it very difficult to think about Johnny’s experience from his 2-year-old perspective. Rather than help him control his aggression, she may convey a sense that the feelings are “bad.’’
If a child gets the idea that his feelings are wrong, these feelings don’t go away. They just become disconnected from the child’s sense of himself. Unable to think about his feelings, he may simply act them out.
Children who have been neglected have no help managing their normal aggression. Those in abusive homes have been hurt by the very person who was supposed to protect them. They may, as a means of coping with this paradoxical situation, identify with the abuser and imitate the behavior as a way of being close.
Given the complexity of the problem, “bully-free zones’’ are clearly an inadequate response. A recent American Academy of Pediatrics policy statement on violence prevention advocates support of early parenting skills and appropriate referral for mental health services.
While the academy’s goals are laudable, from the perspective of my small-town practice, they are largely unattainable.
The primary-care setting is an ideal place to help a parent, particularly one who has herself been traumatized, understand how her own life experiences may be getting in the way of teaching a child to manage aggression. Nurturing parents of young children is our best hope for breaking a cycle of transmission of trauma from one generation to the next.
But pressure from the health insurance industry for primary-care providers to see more patients in less time ensures that a parent is unlikely to open up and receive such support. Getting help for children who have themselves been abused is a daunting task. Access to quality mental health services is severely restricted.
Without meaningful health care reform that places value on primary care and mental health, the bullies will prevail.
Claudia Meininger Gold, a pediatrician, practices in Great Barrington.