“A good name is rather to be chosen than great riches” (Proverbs 22:1)
When I was younger, I used to think that scripture meant that when you were naming your baby, you needed to choose a really good name. Nicholas always seemed like a fine name for a boy, and Alexandra always seemed like a great name for a girl. Many other names, especially trendy names, never appealed to me.
But, of course, that’s not at all what that scripture was about. “A good name” essentially means “a good reputation.”
However, there would certainly be some names that could make make life difficult for your child. Perhaps some of you are familiar with the Johnny Cash song, “A Boy Named Sue.” In essence, his father named him “Sue” because he figured his boy would grow up tough, constantly having to defend himself. What would you expect “Nigel” to look like? I would expect Nigel to have a British accent and would be surprised if he didn’t. Wouldn’t you?
If a name alone can change our perceptions, what about the name “Shaken Baby Syndrome”?
When average people hear the name “Shaken Baby Syndrome,” what do you think goes through their minds? Do they start thinking about subdural hemorrhaging and retinal hemorrhaging? I doubt it. What do they think about? They think that someone took the baby and shook that baby so hard that it wound up in the hospital. They probably don’t have a clue how SBS is diagnosed. All they know is that it’s bad to shake a baby, and that doing so could seriously hurt them. They take the term at face value and probably don’t think much further.
In a hypothetical case, Harmony happens to be sitting down at the breakfast table, scanning the news on her iPad, when she comes across the headline, “Shaken Baby Released from Hospital – Father Charged.” What is going through her mind right now? Yes, her name is Harmony, which probably means that she’s blond, but she’s very smart. But even her smarts are no match for that headline. The baby was shaken. It says so. The doctors say so. But the father is denying responsibility. What? How can he deny that shaking the baby would hurt it? What kind of monster is he! Everyone knows that you don’t shake a baby! She gets angry and posts on the news article that monsters like him do not deserve to have children, and that she hopes that “Bubba shakes the **** out of him in prison.” Whew! Now she can move on to the important fashion news.
Okay, so the article said it was a “shaken baby.” Is anyone reading that article thinking that perhaps the baby fell? That the baby had a stroke? That the baby has a chronic subdural hemorrhage and may have also suffered an event similar to the so-called “Second Impact Syndrome”? Well, if I had to choose, I would choose one of those three items quite often, but I’m not a normal person. For most folks, it is very simple; people assume that the baby was shaken. End of story. Denials by the alleged perpetrator are met with disbelief and incredulity.
Harmony, and most other people, assume that the proof was probably obvious, if they think about “proof” at all. The father must have admitted it, or perhaps the baby’s mother saw him do it. How else would anyone know that the baby was shaken, right? Of course, we know how the diagnosis is often made, but Harmony doesn’t. Neither does Bubba. Nor does Joe Sixpack, although he does have nice abs (I’m just sayin’). They hear “shaken baby” and take that to literally mean that the baby was shaken. No one needs to think past that.
If you have been keeping up with the “SBS debate,” you are probably aware that the doctor who pioneered the diagnosis of SBS, Dr. A. Norman Guthkelch, is now sharply critical of the way the diagnosis is being used and how it is leading to the conviction of the innocent. He suggested using the term Retino-Dural Hemorrhage of Infancy instead, which I suppose could be abbreviated with the not-so-catchy RDHI.
There is a serious epistemological difficulty here: one that seems not to have been clearly recognized. Of the several hundred syndromes in the medical literature, almost all are named either after their discoverer (e.g., Adie’s Syndrome) or for a prominent clinical feature (e.g., Stiff Man Syndrome). In contrast, the appellation shaken baby syndrome (SBS) asserts a unique etiology (shaking). It also implies intent since it is difficult to ‘accidentally’ shake a baby. A newer term, abusive head trauma (AHT), implies both mechanism (trauma) and intent (abusive).
Indeed, Abusive Head Trauma (more or less the new name for SBS) suffers from the same problems. As part of a post to an online article titled “The Real Consensus On Shaken Baby Syndrome,” a poster identifying himself as “Harry Bonnell, M.D.” stated something that has stuck with me.
Abusive head trauma is a diagnosis where the pediatrician not only makes a diagnosis but interprets the intent of how it was inflicted, based on their bias. Police, judge and jury all in one. Perhaps we should change diagnostic codes to “Abusive stab wounds”; Abusive head trauma in adults”; Abusive gunshot wound” After all, none of these could possibly occur accidentally!!!
Indeed, if the doctor diagnosed “head trauma,” it would be left up to the courts to determine whether that head trauma was abusive in nature. With a gunshot wound, we do not immediately assume intent. There are accidental gunshot wounds as well as self-inflicted gunshot wounds. The doctor may have an opinion, which he can state in court, but the victim has a gunshot wound and is treated for it. It really doesn’t matter how the wound got there, and the doctor’s treatment is unlikely to vary if he later discovers that the gunshot wound was accidental. And perhaps more to the point, no one can credibly claim to be able to tell the difference between an accidental gunshot wound and a non-accidental gunshot wound. (I have jokingly said that if you drop a baby on purpose, the infant will develop retinal hemorrhages. If you drop a baby by accident, they will be fine.)
Let’s rewind the clock and also enter into an alternate universe for a moment. Yes, I know how the trips into the alternate universe makes your temporal lobe tingle for a couple of hours, but just bear with me for a moment. But if your temporal lobe tingles for more than a couple of hours, you really should see a doctor. Just don’t tell him about this alternate universe stuff; they never seem to get it.
Okay. One morning, Harmony happens to be sitting down at the breakfast table scanning the news on her iPad, and she comes across the headline, “Baby with RDHI Released from Hospital – Doctors Suspicious.” What is going through her mind right now? Oh, that poor baby… I’m glad he’s doing better. Then, because Harmony is actually quite curious, she does a bit of research on RDHI on Wikipedia, and discovers that it’s possible that this baby was abused, but that there are also other possibilities. She decides that this is a story worth following, but she’s going to wait for an investigation (if there is one), before she condemns an innocent person. And, of course, she inevitably turns her attention to the fashion news.
Bubba and Joe Sixpack, on the other hand… Never heard of RDHI. Don’t know what it is. Don’t really care to. And then they turn to the sports page.
Unfortunately, RDHI is not yet a recognized diagnosis, but SBS is. In fact, that young father that I mentioned earlier just went to trial. The jury was told that the doctor diagnosed “shaken baby syndrome” and that he denied responsibility. He didn’t testify on his own behalf, for whatever reason, and the jury convicted him. What was going through the jury’s mind? I don’t know. But I can make some guesses.
The jury heard from three doctors that he was shaken violently. They also heard from one defense doctor who suggested a couple other possibilities, but he was also paid to testify, and all he did was talk about what else it might have been. I can imagine that many jurors simply assumed that something was being left out. Yeah, yeah… They aren’t supposed to think about that, but they do. Obviously, these doctors know more than they are allowed to say, but what they have said sounds pretty conclusive anyway. Doctors are trained to spot these things, and that’s how we catch these guys. We watch CSI. This seems pretty obvious. He must have shaken the baby, and all he can try to do is blame it on something else. Criminals are dumb. Guilty.
Now try to imagine that trial with doctors up there discussing RDHI. There are three prosecution doctors saying that they think the RDHI was caused by abuse, but they all admit that other things could have caused it, and that they didn’t test for every possibility. Then the defense doctor testifies about some of the major possibilities that were missed. In their deliberations, the jury wonders why these doctors didn’t test for other possibilities and simply assumed that the baby was shaken or otherwise abused. It looks like a rush to judgement. They’ve watched Dr. House on TV. They know that medical diagnoses aren’t 100%, and they know that even what seems likely isn’t always so. But here we have just a couple of symptoms with no other signs of abuse. For the jury, it just doesn’t add up to abuse. Not guilty.
Shaken Baby Syndrome, as a name, is a godsend to prosecutions. The name alone puts an image into people’s minds that is difficult to shake – pardon the pun. I’m not a legal scholar, but it seems like that name alone, with nothing else, is prejudicial, and I’m not the only one who thinks that. In 2006, a Kentucky judge barred SBS testimony and stated, “To allow a physician to diagnose SBS with only the two classical markers, and no other evidence of manifest injuries, is to allow a physician to diagnose a legal conclusion.” You may say that he wasn’t attacking the name directly, but are you sure? If the doctor had diagnosed Retino-Dural Hemorrhage of Infancy would there have been a problem? No. RDHI does not establish that a crime was committed (abuse), nor does it establish what took place (shaking). However, that judge’s ruling was ultimately overturned on appeal.
Personally, I would prefer if doctors were forced to use the term Retino-Dural Hemorrhage of Infancy, but time will tell if this term ultimately gains acceptance. As is often said, a name holds power, and Shaken Baby Syndrome is a very powerful name indeed. The images that it evokes in the human mind are very powerful. Let’s hope that logic, reason, and science ultimately prevail, and that a new name is chosen which more accurately reflects the diagnosis.
Shaken Baby Syndrome False Accusations 