Chapter 4 - Skin Hunger
"Skin Hunger" was a short yet remarkable case study in human development. In chapter four we follow the case of young Laura, a child who cannot seem to grow and gain weight, weighing only 26 pounds at age four, despite having access to the full support of medical and nutritional science, as well as psychological and psychiatric disciplines. We also are introduced to, and spend much of the chapter discussing, Virginia, Laura's loving but physically and emotionally distant mother, and a character called Mama P, who is a zealously affectionate woman and from whom Perry gleans the insight of how the simplicity of love can affect the entire trajectory of a patient's outcome.
This chapter put into perspective for me an entirely new aspect of human development, one that I was unaware could result in the kinds of inhibited physical growth that was seen in Laura's case. Laura, despite receiving the adequate nutrients and being hooked up to feeding tubes in all different manners - an incredibly invasive procedure - was simply not growing. According to the website KidsHealth, the average weight and height of a four-year-old is around 40 pounds and 40 inches tall; other websites put the average between 35-50 pounds. By any of these metrics, Laura is significantly underweight by the time Perry encounters her.
At first, her condition is thought to be a form of childhood anorexia. Her psychologist becomes convinced of the theory that she is somehow purging or exercising excessively at night in order to maintain a low weight. We learn, however, that Laura's inability to gain weight, despite receiving adequate nutrition, is due to underdeveloped regions of her brain resulting from a lack of physical and emotional closeness, which in turn is due to Virginia's own sub-optimal situations growing up.
And while we spend a significant portion of the chapter discussing the mother, Virginia, and anecdotes about Mama P, rather than Laura, the connections that Perry makes between them are clear and sensible. That said, it would not have occurred to me that physical and emotional distance between parent and child is actually capable of having physical consequences as drastic as reducing a child's overall weight and height. Perry likens this to being the runt of a litter of puppies or kittens, which does not receive the appropriate grooming, affection, or nutrition and so is unable to reach its full genetic and environmental potential. The implications of this in human children are terrible, but astounding.
This chapter put into perspective for me an entirely new aspect of human development, one that I was unaware could result in the kinds of inhibited physical growth that was seen in Laura's case. Laura, despite receiving the adequate nutrients and being hooked up to feeding tubes in all different manners - an incredibly invasive procedure - was simply not growing. According to the website KidsHealth, the average weight and height of a four-year-old is around 40 pounds and 40 inches tall; other websites put the average between 35-50 pounds. By any of these metrics, Laura is significantly underweight by the time Perry encounters her.
At first, her condition is thought to be a form of childhood anorexia. Her psychologist becomes convinced of the theory that she is somehow purging or exercising excessively at night in order to maintain a low weight. We learn, however, that Laura's inability to gain weight, despite receiving adequate nutrition, is due to underdeveloped regions of her brain resulting from a lack of physical and emotional closeness, which in turn is due to Virginia's own sub-optimal situations growing up.
And while we spend a significant portion of the chapter discussing the mother, Virginia, and anecdotes about Mama P, rather than Laura, the connections that Perry makes between them are clear and sensible. That said, it would not have occurred to me that physical and emotional distance between parent and child is actually capable of having physical consequences as drastic as reducing a child's overall weight and height. Perry likens this to being the runt of a litter of puppies or kittens, which does not receive the appropriate grooming, affection, or nutrition and so is unable to reach its full genetic and environmental potential. The implications of this in human children are terrible, but astounding.
Laura's case revealed this critical concept and aligned all the pieces for me in a clear and concise way. I feel like I now have an entirely new dimension of assessment to consider. Perry introduces the diagnosis of "failure to thrive," an apparently common diagnostic label, though one that I had never heard before, and places it squarely on Laura's case. Overall, this chapter was an important demonstration not only of what the physical effects of neglect can be, but of what neglect truly is, and how it can be present and hiding in plain sight. Perry emphasizes at several points that Virginia loved Laura, yet he is careful to qualify that she had been neglectful out of ignorance rather than malice.
I too thought “Skin Hunger” was a remarkable case study of “failure to thrive” due to unintentional childhood neglect as you so rightly pointed out. The concept of “neglect” as it relates to children always seems to conger up the idea of malice or self-absorption due to addiction or mental illness but not so in this case. Virginia was just doing what she learned to do while growing with her own form of neglect. The fact that the type of neglect that Laura endured left her 25 to 50 per cent less than the weight of a healthy 4-year-old is remarkable. The social and developmental deficits as a result of her “skin hunger” may be harder to quantify. The other ramification to consider is whether or not Laura will has fully learned from Mama P. on how to attune to, and physically comfort her own child in the future. You pointed out Perry’s analogy of how the runt of the litter is sometimes facing a life or death scenario in potentially being “neglected” by the mother who is driven to give the healthier, more robust offspring the benefit of her attention and nutrition. It’s strange and chilling, through the example of Laura, to recognize that possibility with children in today’s modern society.
ReplyDeleteAlex,
ReplyDeleteI so appreciated how you framed Perry’s insight (into how physical and emotional distance between caregiver and child can cause physiological trauma and impede physical development) as “an entirely new dimension of assessment.” It really is! This chapter illuminated the significant role physical touch and emotional connection between parent and child play in all aspects of human development for me and drove home the actual physiological and psychological consequences that can occur when this connection is interrupted/neglected.
I thought of Spirit Reins and how the clinical practitioners that work with families there may have actually developed an informal assessment measure of this connection by observing whether or not the horse will approach and interact with the caregiver and child in a session based on the horse’s evaluation of how attuned the pair is. While this may not be a completely reliable/valid measure of attunement, it’s a great start and can possibly be verified by the child and parent self-reporting on how emotionally connected/attuned each of them felt in specific moments of the session. I’m curious about other methods of assessment social workers have used in different settings to identify the level of attunement between young clients and their parents. In “Skin Hunger,” it seemed that both Perry and Mama P relied on their own observations and intuitions to identify this lack of deep emotional connectivity between Virginia and Laura. Ultimately, I was grateful that Perry recommended that Virginia and Laura live with Mama P and elated to hear that Mama P was able to model compassionate care and emotional attunement for Virginia and help her rebuild those vital connections with her daughter.
I agree that this chapter gave me a completely new perspective on human development as well! I was thinking is it REALLY possible that a lack of emotional nurturing could have such a drastic effect on a child? Especially when all the other needs of a child are being met. I think for most of us, when we hear the word "neglect" or a "neglectful parent" we think of a parent that doesn't feed or bather their child, let's them cry their eyes out, maybe even a parent who abuses their child physically or psychologically. When Virginia came in with Laura, the doctors did not see this sign of "neglect" so they did not feel the need to explore that issue. As you said, Perry makes a good point in identifying the neglect as ignorance and not malice.
ReplyDeleteVirginia was doing everything to care for her child appropriately as she was taught, but she failed to meet Laura's emotional needs because she does not know how to.
This is where that wholesome approach that I always talk about comes in. I brought it up in another blog response as well, but the collaborative care model that was developed by the University of Washington has done a great job in trying to take a more effective approach at integrating mental health and medical care in one clinical facility. Here is a link if you'd like to read more about this model: https://aims.uw.edu/collaborative-care