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By Expert ID:14027, M.D., FASAM

Sexual abuse cases always hinge on interactions between individuals. Addiction, often unacknowledged, can sometimes provide telltale evidence that changes the outcome of a case. Yet, civil cases of alleged sexual abuse frequently do not consider the implications of a perspective available from addictions medicine. The most relevant aspect of addiction to examine is the concept of addiction as a family disease.

Simply stated, the concept of a family disease asserts that such diseases involve more than one person, and usually more than one generation: none of us invents our own disease. The pattern of inheritance is also not always linear; the child of an alcoholic may become a drug addict, the child of a compulsive overeater may become a compulsive gambler. Addiction may appear to skip a generation; the child of an alcoholic vows never to become an alcoholic, and then exercises such serious controlling behavior that their child takes the grandparent’s route of addiction as an escape from the parent’s suffocating grasp.

I offer the following vignette to demonstrate these principles. Let us call this case Father versus Foster Placement Agency. An enterprising plaintiff’s attorney (call him Jackson) smelled the possibility of damages based on an allegation of sexual abuse. Thus Jackson had undertaken to represent the biological father of two late adolescent children against the Foster Placement Agency that had placed his children in two separate families at the ages of three to seven years of age. The foster fathers in both families had allegedly sexually abused each of the children during the placement, and since neither foster father had deep pockets (one was serving a prison sentence for sexual molestation), the plaintiff’s attorney first sued (unsuccessfully) the state agency responsible for child welfare, and then proceeded to sue the foster placement agency. I was hired by the attorney who represented the board of directors of this agency.

Initially, Jackson was able to establish that one of the two foster fathers had been diagnosed as an alcoholic, and the other had been diagnosed as depressed prior to the placement of the children in the families. A psychiatrist had been retained to testify that placing a child in the family of an alcoholic or depressive was inappropriate, and that either of these diagnoses would predispose to sexual abuse. These kinds of generalizations are seldom true much less supported by any systematic research, and strongly suggest that consultation with a specialist in addictions would be indicated.

Though the children’s mother had been diagnosed with schizophrenia, she had a serious problem with alcohol and drugs, and the biological father may also have been involved in drug dealing. The biological father had apparently left the mother before the children were taken away from the mother due to abuse and neglect. Even with these pre-existing traumas, Jackson was alleging that the children’s pathology was proximally related to the abuse in the foster homes. Since the children were clearly impaired, the process of sorting out which symptoms were related to which traumas seemed complicated to tease apart, but here the concept of addiction as a family disease became very useful. Therefore, I was not entirely surprised when I discovered, buried in the records of the family medical history, a description of how when the children were being removed from their mother’s care, a sexual abuse evaluation was performed using anatomically correct dolls. This evaluation showed evidence of sexual abuse prior to the time of placement in foster care. In fact, the children’s mother had alleged sexual abuse of the daughter by the father at that time. Clearly, if this sexual abuse had occurred prior to the placement in foster care, the plaintiff’s case would be seriously weakened.

In another deposition of a psychiatrist called upon as an expert witness, Jackson asked if this witness was aware of the fact that the children’s mother was known to have possessed a set of anatomically correct dolls. I can only imagine that Jackson’s intent was to vitiate the claim that the clinical evaluation had any validity, based on the theory that the mother was delusional in her belief that the father had sexually abused their child, and that her possession of the dolls was evidence of her psychosis. During my deposition, Jackson asked about my opinion of the effect of the trauma that the children suffered during their stay in foster care. Based on the support which Jackson had inadvertently offered me, I was able to state categorically that the effect was unknowable. Jackson had let the cat out of the bag by sharing the information about the mother’s possession of anatomically correct dolls. Such possession was virtual proof that the mother had attempted to indoctrinate her children from an early age that they had been sexually abused by their father. Such brainwashing would be in and of itself be profoundly traumatic, and render any ability of the children to recognize real sexual abuse untenable.

Since Jackson was oblivious to the implications of addiction as a family disease, he was totally unprepared to understand that his attempt to disarm a small point in his case would result in the complete undermining of his client’s allegations. The use of a systems perspective would have helped Jackson avoid this self-sabotage, but was used by the defense to dismantle an otherwise troubling case. Applications of this perspective are much more frequent than generally appreciated, and would be usefully considered any time either sexual abuse or addiction is involved with damages claimed by a plaintiff.

By Expert ID:14027, M.D., FASAM