Life Crisis as a Precursor to Child Abuse

BLAIR JUSTICE, PhD, and DAVID F. DUNCAN, BA

CHILD ABUSE can be regarded as a major public healthproblem (1,2). Kempe reports that roughly 25 percentof all fractures seen in the first 2 years of life and 10to 15 percent of all trauma seen in the first 3 years aredue to abuse by parents or parent surrogates (3,4).The true prevalence of child abuse is difficult to esti-mate. According to Gil (5), 6,617 cases were reportedin 1968. Estimates of the total number of actual casesper year range from Zalba's estimate of 200,000 to250,000, with 30,000 seriously hurt (6), to Light's of ahalf-million (7), to Gil and Noble's of an upper limitof between 2.5 and 4.1 million (8).What distinguishes the abusing family from the non-

abusing one? We have found that people who abuseare neither cruel maniacs nor even parents who do notlove their children. For the most part they are notinsane they defy psychiatric classification as a group(9). Therefore, how do they differ from parents whodo not abuse?One answer is provided by the environmental-stress

theorists, as represented by Gil. In his nationwide case-register study, Gil (5,10) found that reports of childabuse were concentrated among the poor. Child abusemay, therefore, be regarded largely as being one moreaspect of the lifestyle associated with the poverty syn-drome. In Gil's words (10), "Life in poverty generatesmany additional stressful experiences which . . . arelikely to become precipitating factors of child abuse.The poor are subject to the same psychological condi-tions which may cause violent behavior toward childrenas are the non-poor; but in addition to this, they aresubject to the special environmental distresses andstrains associated with socioeconomic deprivation."Gil's approach should not be misinterpreted as a single-cause theory. Rather, it is one which emphasizes socialand cultural influences and particularly the stressesassociated with an inegalitarian society (11).A similar viewpoint is present in Gelles' social-

psychological theory of child abuse (12). Essentially,Gelles sees child abuse as a particular form of adapta-

tion to stress. Considering also such factors as societalvalues and norms, socialization experience, and "psy-chopathic states," Gelles emphasizes such stress areasas socioeconomic position of parents, marital stresses,excess children, unemployment, social isolation, un-wanted or "problem" children, and immediate pre-cipitating situations such as an argument or childmisbehavior.The foremost theory in the field of child abuse is

the psychodynamic one developed by Kempe (3,4),Helfer (13), and Steele and Pollock (9). This approachpresents a three-factor theory of the causation of childabuse. The three factors as described by Helfer (13)are: First, the parent must have the potential to abuse,primarily as a result of receiving an inadequate"mothering imprint" in his or her own childhood.Second, the child must be seen by the parent as being"special" whether he really is or not. Third, a crisismust occur which precipitates the incident of abuse.

In the psychodynamic theory, stress also plays a part,but only as a precipitating event. This crisis may be asmajor as a husband being drafted or as not havingenough money to buy food, or it may be as small as awashing machine breaking down (3,4,13).

Each of the preceding briefly summarized theoriesgives stress an important part in the causation of childabuse, whether as a basic cause, a precipitating event,or both. Stress in each case is viewed as an aversivestate or incident. It is something unpleasant thathappens to a person.An alternate conception of stress, based on change,

has been developed within the field of psychosomaticmedicine. This approach grew out of Meyer's (14)"life chart" that arranged for each patient a recordof ". . . changes of habitat, of school entrance, gradua-tions or changes or failures; the various jobs, the datesof possibly important births and deaths in the family,and other fundamentally important environmental in-fluences" which could be charted against changes inphysical or mental health. In this approach stress is

110 Public Health Reports

regarded as a situation which requires adaptation orcoping behavior by the affected person, whether thatsituation is experienced as pleasant or unpleasant.Thomas Holmes, Richard Rahe, and their associates

at the University of Washington built on Meyer's (14)earlier work in describing the influence of life eventson the onset of illness. Holmes and Rahe (15) devel-oped the Social Readjustment Rating Questionnairethat listed 43 events requiring some readjustment bythe person to whom the event occurred. These eventswere assigned a numerical value which represented anestimate of the magnitude of change in adjustment re-quired in response to the event (15,16). This listing oflife events, each with a numerical value of "life changeunits," became the Social Readjustment Rating Scale(15), the most widely used measure of life stress inpsychosomatic research.

Life Crisis StudyLife change. To assess how life stress and other fac-tors may be associated with child abuse, we adminis-tered a questionnaire to two groups of parents. Thequestionnaire included 39 questions and the SocialReadjustment Rating Scale (15). The first group con-tained 35 abusing parents. Where the families wereintact, both parents were given the questionnaire, ratherthan just the parent who had injured the child. Webelieve, as do other investigators, that both parentsare involved in abuse no matter which one actuallyinjures the child (1,17). All the abusive incidents hadoccurred within the past year.The second group also contained 35 parents-similar

in age, education, and economic status to the abusingparents-who had difficulties with their children butwho had never abused them. The nonabusing parentswere attending workshops on parenthood skills con-ducted under the direction of one of us (Justice) forthe local Model Cities agency. These parents hadexperienced such problems with their children astemper tantrums, lying, stealing, fighting, and truancy.

Both groups of parents included a cross section ofsocioeconomic classes weighted toward lower-middleand working-class families. The most striking differ-ences between the abusive and the nonabusive parentsemerged on the Social Readjustment Rating Scale,depicting life events for the two groups during the 12months preceding their troubles with their children.

It was evident that the abusing parents had under-gone too much change too fast. The number andmagnitude of changes to which they had to adjustconstituted a "life crisis" that had existed during atleast the 12 months before they became abusive. Mostof the nonabusers had not experienced a life crisis dur-ing the year before their problems began with theirchildren.A rapid series of changes in a person's life is more

difficult to deal with than a situational crisis such asa divorce, loss of a job, or sickness. In a situational

crisis, a person's defenses weaken when the stress ismost severe-but he has time to mobilize new resourcesto deal with the problem. If he deals with it success-fully, he comes out of the crisis at a higher level offunctioning-with greater emotional equilibrium-thanwhen he went into it (18). In a life crisis there is aseries of situational events compressed together andsometimes accompanied by maturational crises-achild's leaving home or parental remarriage, pregnancy,or retirement.The following are the situational and maturational

crises that both groups of parents were asked about.The 43 items constitute the Social Readjustment Rat-ing Scale that has been found to predict onset of ill-ness, accident, or injury (15). As shown, each itemis weighted in terms of the amount of readjustmentnecessary to cope with the event-death of spouserequiring the most readjustment (and assigned a nu-merical value of 100) and minor violations of the lawthe least (value of 11).

Item Life changeNo. Life event unit value

l____Death of spouse ------------------------- 1002____Divorce________________________________-733____Marital separation ----------------------- 654____J ail term ------------------------------- 635----_Death of close family member ------------ 636____Personal injury or illness ----------------- 537----_Marriage_____________--________________ 508____Fired at work -------------------------- 479____Marital reconciliation -------------------- 4510----Retirement ----------------------------- 45ll___Change in health of family member 4412____Pregnancy ------------------------------ 4013____-Sex difficulties -------------------------- 3914____Gain of new family member --------------- 3915____-Business readjustment ____________________ 3916____Change in financial state ----------------- 3817____-Death of close friend -------------------- 3718____Change to different line of work ----------- 3619____Change in number of arguments with spouse -_ 3520____Mortgage over $10,000 ------------------- 3121 ___Foreclosure of mortgage or loan ------------ 3022____Change in responsibilities at work --------- 2923____Son or daughter leaving home ------------- 2924____-Trouble with in-laws -------------------- 2925___Outstanding personal achievement --------- 2826____Wife begin or stop work ------------------ 2627____Begin or end school ---------------------- 2628____Change in living conditions --------------- 2529____Revision of personal habits --------------- 2430____Trouble with boss ----------------------- 2331____Change in work hours or conditions --------- 2032____Change in residence ---------------------- 2033____Change in schools ------------------------ 2034____-Change in recreation --------------------- 1935____-Change in church activities ---------------- 1936____-Change in social activities ----------------- 1837____Mortgage or loan less than $10,000 -------- 1738____Change in sleeping habits ---------------- 1639____Change in number of family get-togethers 1540____Change in eating habits ------------------ 1541 ----Vacation _______________________________ 1342____Christmas ------------------------------ 1243____-Minor violations of the law ---------------- 11

March-April 1976, Vol. 91, No. 2 111

D Dr. Justice is professor of social psychology and Mr.Duncan is research statistician, Community HealthPractice Module, University of Texas Health ScienceCenter at Houston School of Public Health. Tearsheetrequests to Dr. Blair Justice, P.O. Box 20186, Houston,Tex. 77025.

The abusing parents had high scores on the SocialReadjustment Rating Scale-which meant, as we havenoted, that they had experienced excessive change intheir lives during the 12 months before they begantheir abuse. This change consisted of a series of situa-tional and maturational crises that exceeded theirability to adapt. We postulate that, unlike personsundergoing a single situational or maturational crisis,these abusing parents have no time to regroup beforea new crisis occurs. In terms of Selye's three stages ofresponding to stress (19), they no sooner go throughthe first phase of shock and countershock and begin toenter the second stage of resistance when a new crisisplunges them into a third stage of exhaustion-thestage in which their defenses are lowest and theircontrols on acting out are weakest.The mean score on the rating scale was 234 for the

35 abusing parents and 124 for the 35 nonabusingparents. These means are significantly different at the.001 level by the t test. A score of more than 150 isclassified by Holmes and Rahe (15) as representinga life crisis. Scores of 150-199 are classified as a mildlife crisis; 200-299 as a moderate life crisis; and morethan 299 as a major life crisis. The distribution of lifechange scores for the two groups is shown in thefollowing table. The distributions are significantly dif-ferent at the .001 level: X2 - 25.69, P < .001; tind _4.28, P < .001.

Life changescores0-149, no crisis150-199, mild crisis200-299, moderate crisis300 or higher, major crisis

Abusers ControlsX = 233.63 X = 123.62

4 259 514 38 2

We found a distinguishing factor of change, ratherthan of economic or even environmental stress, andchange requires constant readjustment. Although it ispossible to accommodate to continuous stress from asingle source, excessive change is constantly throwinga person off balance. In a life crisis it is as though aperson never has time to catch his breath, to mobilizehis resources, before another change occurs. Changerequires decision making and problem solving. Lifecrisis requires a person to stay constantly on the alert,waiting for the new and uncertain to happen withoutany way to predict or prepare for what is coming next.We are not saying that excessive change-constitut-

ing a prolonged life crisis-is the sole cause of childabuse. Our views on the multi-causal nature of child

abuse are presented elsewhere (1,17). Life crisis, how-ever, does appear to be an important predisposingfactor that has not been investigated previously. Itdeserves further research because the trend in oursociety is toward greater change in less time.We wish to emphasize that our findings regarding

the part played by life crisis in abuse is far differentfrom what many other investigators, mentioned earlier,have noted about the role of stress and situationalcrisis. We have no argument with the example thatthe breakdown of a washing machine may represent acrisis to a parent with the potential for abuse and cantrigger an explosive outburst. We do not quarrel withthe concept that those who abuse are under pressure.However, our findings suggest that the reason that abroken washing machine-or some other seeminglyminor problem-may loom so large is that the parenthas been bombarded for months with a series of stress-ful changes. He or she is at a low point in ability tocope with even minor problems and to exercise usualcontrol over lashing out at others.

It is the life crisis-the prolonged series of changeevents-that is the key to the predisposition of theparent to abuse, not the situational upset that is simplyan appendix to that life crisis. Similarly, it not day-to-day economic pressure and stress that frame thecontext in which abuse occurs. It is the unpredict-ability of all kinds of changes, most of which havenothing to do with the threat of poverty. Again, theend state of the life crisis is a stage of exhaustion, ofdecreased ability to adjust, and increased risk of losingcontrol.An important question that remained was why a

person who undergoes a life crisis would abuse a child.If excessive change can lead to illness, accident, orinjury (15), why would it lead instead to violencetoward a child? We do not know that child abuse is asubstitute for the other outcomes. From our work withabusing parents, we know that a large percentage dohave serious illnesses and accidents. For child abuseto be an outcome of a life crisis, other factors mustalso be present. Some of the most critical of thesefactors were also suggested by our study findings.

Symbiosis. In addition to the striking differences wesaw in terms of life change units of the two groups,there was also a significant difference in answers toanother set of questions related to the crucial issueof symbiosis. As defined by the Schiffs (20), symbiosisis the kind of attachment that a person establisheswith someone else in an effort to get taken care of.The second party is to make all the decisions and tosee that the first party's needs are met. This is ahealthy and necessary relationship between motherand infant, but it is destructive when it occurs betweenadults or when a parent reverses roles and tries to getthe child to take care of the parent. It has been sug-gested that symbiosis between parents and between

112 Public Health Reports

parent and child may be a causal factor in child abuse(1,17,21-23).Four questions in our study (not on the rating scale)

that related to symbiosis elicited sharply different an-swers among the abusing group compared to the con-trol group. In the abusing group, parents were morelikely to say that they believed their spouses had acloser relationship to their children than they did (chi-square probability of less than .02). The abusing par-ents also were more inclined to answer that they hadtrouble getting their spouses to discipline the children(chi-square probability of less than .04). In addition,the abusing parents were five times more likely thanthe controls to reply that they had trouble getting theirspouses to make decisions (chi-square probability ofless than .05).The answers of the abusing parents are typical of

persons who have a symbiotic relationship. In theabusing family there is constant competition over whois going to get taken care of. The spouses are in com-petition with each other first, but when one "loses" andhas to take care of the other, the loser then may turnto the child in a last-ditch effort to get taken care ofhimself. When the child fails to deliver, a lifetime ofmounting frustration from unmet dependency needs islikely to be unleashed in the form of overt aggressiontoward the child. This is particularly true, we believe, ifthe person has undergone a life crisis experience suchas we have described, which impairs defenses and con-trols on acting out violently.

In light of the concept of symbiosis, it would beexpected that the abusing parent would see his spouseas being closer to the child because he constantly feelshe is losing in the struggle to find someone in thefamily to meet his needs. Likewise, it would be ex-pected that he would believe that his spouse shirksresponsibility to discipline the child and to make deci-sions. Again, in our view, the abusing parent perceiveshimself as having to carry the bigger burden in thefamily and to shoulder responsibilities that othersshould assume. The abusing parent sees himself asapart from other people, losing out in the "competi-tion" for love and comfort from others. In our workwith abusing families, the issue of discipline and deci-sion making is a source of frequent strife betweenspouses. Much anger is generated in the struggle toget the other to do the "parenting" in the family, tomake the decisions, and to discipline the child. In ourexperience, discipline in the abusing family is oftenonly one kind: physical punishment. The child isbeaten when he fails to meet the excessive expectationsof the parent, who is constantly wanting to be caredfor himself.The struggle to establish symbiosis was also reflected

in how the abusing parents responded to certain itemson the Social Readjustment Rating Scale. The mosthighly significant differences between the abusing par-ents and the nonabusing ones were in the higher fre-

quency with which the abusers reported "sex diffi-culties," "change in financial state," "trouble within-laws," and "change in living conditions." (Chi-square probabilities less than .02, .005, .0001, and .0005,respectively, at 1 degree of fredom.) The abusing groupexperienced problems in these four areas much morethan did the nonabusers. Our work with parents whoabuse confirms these findings.We believe that sexual difficulties are often present

because the spouses are engaged in internecine war-fare to make one take care of the other-neither part-ner is willing to try to satisfy the other. Instead, eachdemands to be satisfied himself or herself. In lightof this formulation, the sexual difficulties betweenspouses also may reflect unresolved problems in otherareas of daily life. Many abusing parents we haveworked with have never learned to get close to others.They are distrusting. They are not inclined to discussproblems that they are having with their mates. Theymay pout or stew in silence. All of this often findsexpression in problems with sexual relationships.

As for "change in financial state," we have observedthat the abusing parent often goes through many upsand downs in terms of income and expenditures. Thisdoes not mean that they are necessarily poor. In ourexperience, these financial fluctuations usually reflectthe problem we discussed earlier that abusing parentshave with making decisions and assuming responsi-bility. They often tend to put things off, even criticalthings like paying bills. The abusing parent is likelyto get into financial trouble from overspending. It is asif he thinks someone else will pay the bills for him.He wants to be rescued, to be cared for. He may lay offwork to the point of losing money and getting intofinancial straits. He has trouble accepting responsi-bility for making ends meet and bringing in a steadyincome. He may change jobs often. And because ofthese changes living conditions also fluctuate. Thesame pattern of ups and downs occurs in the livingconditions as in the financial states of couples who aretrapped in symbiotic relationships.

In terms of trouble with in-laws, the struggle oversymbiosis is expressed through seeing the in-laws asadditional competitors for attention. The abusing par-ent is easily threatened by others who may interferewith his quest to be cared for. In-laws may divert theattention of the abuser's spouse or child. They mayrefuse to cooperate in giving him the attention and.care he wants. They incite jealousy and resentment.As noted, sex, finances, living conditions, and in-laws

account for the most highly significant differences be-tween abusing parents and nonabusers in terms of lifechange events. When all 43 items are taken as awhole, the abusers still differ markedly from the non-abusers. Does this mean that abusing parents are justmore unfortunate victims of the vagaries of life, ofchange over which they have no control? Our answeris "No." Certainly, there are changes-such as "death

March-April 1976, Vol. 91, No. 2 113

of spouse" or "death of close friend"-over which theyhave no control. But, many of the changes that char-acterize their lives are self-induced.The 43 items listed fall into several categories:

family, marriage, occupation, economics, residence,group and peer relationships, education, religion, rec-reation, and health. Most of the changes representedby these categories are the products of a particularkind of personality interacting with others and theenvironment. We believe that the abusing parent'spersonality is such that he brings many changes onhimself.From our experience, the abuser is inclined to be

isolated, distrusting, impatient, in conflict with his orher spouse, and has a low self-image. Primarily, how-ever, the abuser is in search of a symbiotic relationship-of an attachment with someone who will makedecisions for him, assume responsibility for him, takecare of him, and in short be a parent to him. Thus,the abuser is likely to subject himself to a state of lifecrisis as represented by excessive change that requiresenormous amounts of constant readjustments. The lifecrisis will put him in a stage of exhaustion, withlowered defenses and weakened control over his be-havior (18,19,24,25). The combination of life crisisand symbiosis will predispose him to abuse.

Prevention of Child AbusePrevention of child abuse may be based on the tradi-tional public health model of host, agent, and environ-ment (1,17). The parents may be viewed as the host,the child as an agent whose presence is necessary butnot sufficient for abuse to occur, and the environmentof abuse-as our investigation shows-is fraught withchange arriving too rapidly for successful adjustment.To prevent the abuse of children we must recognizethat this is an interactive system in which both parents,the child, and the physical, social, and cultural environ-ments play a role.The life crisis contains elements of host as well as

environment. As we have already discussed, people whoare deeply involved in symbiotic behavior also havelife crises. We have suggested that this may be a causalrelationship and that therefore we can approach thereduction of life crises by helping the parent to changehis behavior, as well as by restructuring the environ-ment. We can work to break up the pattern of sym-biosis and teach the parent to be a whole personcapable of accepting responsibilities and making deci-sions for himself or herself and capable of taking careof others as well as being taken care of.

In terms of environmental manipulation, we cannotslow down those elements of rapid change that occurin everyone's life, but we can try to build elements ofstability into our society. We can also develop servicesto assist people in adjusting to crises in their lives-hotlines, drop-in centers, temporary homemaker serv-ices, and best of all, old-fashioned good neighbors. We

can try to educate the public about the need for timeto adjust to rapid change and we can, through themedia, "give permission," for people to ask for helpwhen they need it without feeling embarrassed orinadequate.

Another preventive approach might use the predic-tive value of the Social Readjustment Rating Scale.Public health nurses might be assigned to call on suchhigh-risk groups as unemployed parents and parentswith drug abuse histories, premature babies, or illegiti-mate babies (1,2,5,17). The public health nurse, inaddition to performing health screening and givinginformation on child health and development, couldalso administer the Social Readjustment Rating Scaleto the parents to determine how much change theyhave had to adjust to in the last year. Parents withhigh scores on the scale would receive particular atten-tion and more frequent visits. Steps could be taken,in terms of counseling, guidance to sources of supportand assistance, and medical intervention, to reduce thestressful effects of excessive change in the parents' lives(17). We believe that such a program would avertchild abuse in many cases. Such an intervention strategycould also produce dividends in many other areas ofsocial and personal well-being (15,18,24,25), in addi-tion to child abuse, and thus justify the high cost ofan extensive early intervention program.We could also prevent life crises if we could reduce

geographic mobility caused by unemployment or lackof opportunity. If we could reduce the frequency withwhich families must be uprooted in order to find newemployment or obtain-advancement, we could affectthe multiple changes which created life crises in thechild abusers we studied. Increased opportunities forfurther training and advancement on the job couldmake changes of residence and hours less common.At the same time, industry could, and we believeshould, accept a greater responsibility for easing thetransitions necessary when an employee is transferredfrom city to city or even from shift to shift. When aperson finds roots in a job with a future, he precludesa number of other changes in his life-including thosethat may affect his marriage, his residence, his livingstandards, and his recreation.The development of better health care delivery

systems may also help to reduce life crises. Effectivehealth maintenance should certainly reduce the numberof abrupt changes in the health status of the potentialabuser. The provision of counseling and mental healthservices as part of a truly comprehensive health mainte-nance organization could help to reduce such signifi-cant life change factors as sexual difficulties, troublewith in-laws, and disturbances of sleeping habits-allproblems to which the child abusers in our study hadto adjust. Thus, the health maintenance organizationor similar innovations in health services delivery mayplay a meaningful role in the prevention of child abusethrough the reduction of health-related stress.

114 Public Health Reports

References1. Justice, B., and Duncan, D.: Physical abuse of children

as a public health problem. Public Health Rev 4: 183-200 (1975).

2. Bishop, F. I.: Children at risk. Med J Aust 1: 623(1971).

3. Kempe, C. H.: The battered child and the hospital.Hosp Practice 4: 44-51 (1969).

4. Kempe, C. H.: Pediatric implications of the battered babysyndrome. Arch Dis Child 46: 28-37 (1971).

5. Gil, D.: Violence against children. Harvard UniversityPress, Cambridge, 1970.

6. Zalba, S.: Battered children. Transaction 8: 58-61(1967).

7. Light, R.: Abused and neglected children in America:a study of alternative policies. Harvard Ed Rev 43: 556-598 (1974).

8. Gil, D., and Noble, H.: Public knowledge, attitudes andopinions about physical abuse in the U.S. Papers in SocialWelfare, No. 14. Florence Heller Graduate School forAdvanced Studies in Social Welfare, Brandeis University,Waltham, Mass. 1967.

9. Steele, B. F., and Pollock, G. H.: A psychiatric studyof parents who abuse infants and small children. In Thebattered child, edited by R. E. Helfer and C. H. Kempe.University of Chicago Press, Chicago, 1968.

10. Gil, D.: Physical abuse of children: findings and impli-cations of a nationwide survey. Pediatrics 44: 857-864(1969).

11. Gil, D.: Unraveling child abuse. Am J Orthopsychiatry45: 352-355 (1975).

12. Gelles, R. J.: Child abuse as psychopathology: a socio-logical critique and reformulation. Am J Orthopsychiatry43: 611-621 (1973).

13. Helfer, R. E.: Child abuse and neglect self instructionalprogram. National Center for the Prevention and Treat-ment of Child Abuse and Neglect, Denver, Colo., 1973.

14. Lief, A., editor: The commonsense psychiatry of Dr.Adolph Meyer. McGraw-Hill, New York, 1948.

15. Holmes, T. H., and Rahe, R. H.: The social readjustmentrating scale. J Psychosom Res 11: 213-218 (1967).

16. Masuda, M., and Holmes ,T. H.: Magnitude estimationsof social readjustments. J Psychosom Res 11: 219-225(1967).

17. Justice, B., and Justice, R.: The abusing family. BehavioralPublications, New York. In press.

18. Caplan, G.: Principles of preventive psychiatry. BasicBooks, New York, 1964.

19. Selye, H.: The stress of life. McGraw-Hill, New York,1956.

20. Schiff, A. W., and Schiff, J.: Passivity. Trans Analysis J1: 1 (1971).

21. Justice, B., and Justice, R.: "Siamese twinning" in scriptsof child batterers. Paper presented at International Trans-actional Analysis Association Summer Conference. SanFrancisco, August 1973.

22. Justice, B., and Justice, R.: A psychosocial model ofchild abuse: intervention strategies and group techniques.Paper presented at Clinical and Research TrainingSeminar, Texas Research Institute of Mental Sciences,Houston, Tex., February 15, 1974.

22. Justice, R., and Justice, B.: TA work with child abuse.Trans Analysis J 5: 38-41 (1975).

24. Langer, T. S., and Michael, S. T.: Life stress andmental health. Free Press of Glencoe, Glencoe, Ill., 1963.

25. Duncan, D. F.: Life stress as a precursor to adolescentdrug dependence. Int J Addict. In press, 1976.

-SYOPSJ[SJUSTICE, BLAIR (University of TexasHealth Science Center at HoustonSchool of Public Health), and DUN-CAN, DAVID F.: Life crisis as aprecursor to child abuse. PublicHealth Reports, Vol. 91, March-April1976, pp. 110-115.

A number of theories have beenproposed on the causation of childabuse, and many of these theoriesassign some role to stress. Stress isvariously conceptualized as a con-tinuous state resulting from poverty,poor housing, and the like, or as animmediate crisis such as an argu-ment or the breakdown of an appli-ance.

An alternate perspective on stressidentifies it with life change eventswhich require readjustment In thelifestyle of a person. When an exces-sive number or magnitude of such

life change events occur, the personaffected may be said to be in a stateof life crisis. Such states of lifecrisis have been found to be asso-ciated with the onset of physical ill-ness and with the occurrence ofaccidents and' injuries.

In this study, a questionnaire wasadministered to 35 abusing parentsand 35 matched controls who hadexperienced problems with their chil-dren but had not been abusive. Thetwo groups were compared for theirlife change scores on the Social Re-adjustment Rating Scale for the yearbefore their abuse or problems beganwith their children. The mean scoreof the nonabusers was 124, whichdoes not indicate a life crisis. For theabusers, the mean score was 234,which indicates a moderate life crisis.These means are significantly differ-ent at the .001 level by the t test.The role of symbiosis, an emo-

tional attachment in which a personseeks to be taken care of by an-other person, was also explored. Itis argued that abusive parents arecompeting with each other and withtheir children for the role of beingcared for. This kind of behaviorseems to make the person particu-larly vulnerable to life changes,which in turn produce stress. Sup-port for this view was found In theresponses to the questionnaire.

Prevention strategies aimed at re-ducing change and stress might in-clude better provision of crisis-inter-vention services, measures aimed atreducing unemployment or lack ofopportunity, effective health main-tenance services, and greater provi-sion of counseling and mental healthservices. Use of the Social Read-justment Rating Scale in a preven-tive program of early intervention isalso possible.

March-April 1976, Vol. 91, No. 2 115