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Dr. Sarah Ravin

Welcome to my professional blog. I am a Florida Licensed Psychologist and trained scientist-practitioner. In 2008, I received my Ph.D. in clinical psychology. A major component of my professional identity is staying informed about recent developments in the field so that I may provide my clients with scientifically sound information and evidence-based treatment. There is a plethora of information on the internet about Eating Disorders, Depression, Anxiety, Psychotherapy. Unfortunately, much of this information is unsubstantiated and some of it is patently false. It is my hope that by sharing my thoughts and opinions on psychological issues, with scientific research and clinical experience sprinkled in for good measure, I can help to bridge the gap between research and treatment.

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Tag: law

Friday, August 6th, 2010

A Dangerous Precedent

Earlier this week, a federal judge ordered the Pittsburgh Public Schools to pay $55,000 to settle a lawsuit filed by a mother, who claimed her adolescent daughter was bullied into anorexia.

According to the lawsuit, the plaintiff’s daughter, now 15, was bullied relentlessly at school in 6th and 7th grades. A group of boys taunted her and made degrading remarks of a sexual nature, insinuating that she was fat and ugly. The girl stopped eating lunch at school in attempt to avoid being teased by these boys, who ridiculed her for eating and being fat. Although the girl’s teacher, principal, and guidance counselor were aware of the bullying, they did nothing to intervene. The girl began losing weight, and by the middle of her 7th grade year, her weight was dangerously low and she was diagnosed with anorexia nervosa, for which she was treated at an inpatient psychiatric clinic. The plaintiff, whose daughter now attends private school, sued the school district, her daughter’s middle school, and her principal, claiming that her daughter developed anorexia as a result of their inaction.

I disagree with this ruling, and I think it sets a dangerous precedent.

Before I state my points of contention, I will make several points very clear:
• Bullying has the potential to cause extreme distress. It is cruel, harmful, and absolutely inexcusable.
• All schools should have clear, written policies about bullying and sexual harassment. All students, parents, and faculty must be aware of these policies. School faculty and administrators must enforce these policies to the best of their abilities.
• School faculty and administrators have a responsibility to provide a safe learning environment for all students, and have a duty to intervene at the first sign of bullying.
• Students who engage in bullying behavior should be punished appropriately. If the bullying continues, they should be expelled.

In this particular case, the bullies did some terrible things; they must be held responsible for their actions and punished appropriately. The school faculty and administration were certainly negligent; they must be held accountable for their inaction and punished appropriately. The school district was remiss not to have a bullying policy, and they should be compelled to create one. The victim suffered horribly as a result, and she deserves to heal from this trauma and to attend school in a safe environment. And the buck stops here. I do not believe that the bullies or the negligent school personnel are responsible for this child’s mental illness.

To create a legal precedent in which school officials are held legally or financially liable for a child’s mental illness is dangerous on several levels:
• It implies that the actions of children can cause another child to develop a mental illness.
• It implies that the actions or inactions of adults can cause a child to develop a mental illness.
• It implies that anorexia nervosa is (or can be) the result of teasing or bullying.
• It reinforces the popular but antiquated and unsupported notion that anorexia nervosa is the result of some deep-seated trauma.
• It implies that this child would not have developed anorexia nervosa if she had not been bullied.
• It neglects the horrific experiences of tens of thousands of other children who have been bullied and have suffered silently, but have not developed anorexia nervosa.
• It invalidates the experiences of the tens of thousands of children and adults who have never been bullied or traumatized in any way, but nonetheless have developed anorexia nervosa.

Imagine being a prepubescent boy and being held responsible for causing a classmate’s severe mental illness. Don’t get me wrong – I am in no way defending the behavior of these bullies. They did cruel things and they must be punished. But they did not make this girl develop a life-threatening brain disorder. They couldn’t have, even if they wanted to! Similarly, the school faculty and administrators were obviously negligent and made some terrible mistakes, but they did not cause this child to develop a mental illness.

The most recent scientific evidence strongly suggests that anorexia nervosa is a biologically-based, genetically transmitted brain disorder which is triggered by malnutrition and then becomes self-perpetuating. Children with anorexia come from all walks of life. Some are popular, confident, social, happy, and well-adjusted before their illness begins. Others are depressed, anxious, introverted, teased, or unstable before they develop anorexia. Some children develop anorexia after a stressful event, which could be as benign as a starting middle school or as serious as rape. For many children, the onset of anorexia nervosa does not coincide with a major stressor, but rather spirals out of control during an attempt to “eat healthy,” get in shape for sports, or lose a few pounds for prom.

My point is that some children are simply “wired” for anorexia nervosa, which can be triggered by relatively minor stressors or relatively benign bouts of under-nutrition. It doesn’t make sense to “sue the trigger” when it is just that – a trigger. If we can sue a school district – and win tens of thousands of dollars – for allowing a child to be bullied into anorexia, where does it end? If a child develops an eating disorder after reading a book on nutrition, do we sue the publisher? If an 18-year-old becomes anorexic while struggling to adapt to the social and academic challenges of college life, do we sue the university?

If a teenager develops and eating disorder after being raped, the rapist should be tried and convicted and incarcerated. But the eating disorder, in my opinion, is irrelevant to the outcome of the trial. The rapist should be incarcerated for the same length of time (for life, in my opinion) regardless of whether the victim develops any mental illness afterwards, because he committed a violent crime. The crime is no more or less heinous based upon the particular pre-existing neurological makeup of his victim.

It is well-known amongst mental health professionals that a psychotic break can be triggered by “high expressed emotion,” such as bullying or family conflict, in a person who has the underlying neurobiological predisposition. Do we then sue the school for allowing a child to be “bullied into schizophrenia?” Do we sue the parents for arguing too much and thus causing their son’s psychosis?

I have the deepest sympathy for this plaintiff, and especially for her daughter. No doubt, they have both suffered horribly. This mother is only doing what she believes is best for her dear child, and I’m sure she believes she is helping other children in the process. The judge who approved of this settlement is, likewise, only trying to ensure that justice is served. He or she probably has no intimate knowledge of the etiology of anorexia nervosa, and probably has no idea what some of the negative ramifications of his ruling could be.

If the lawsuit had been simply about protecting children from bullying, I would have supported it 100%. I cannot, however, support a lawsuit which enshrines bullying as a legally valid cause of anorexia.

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