04/25/2012 06:22 pm ET Updated Jun 25, 2012


Bully, a new movie about high school students tormenting each other, is getting much attention. Bully situations can escalate and bubble up to a breaking point that results in innocent victims and families suffering needlessly and, in extreme situations, suicide. In the aftermath of such a catastrophe, the media usually questions -- 1) Could this have been predicted? 2) How might this have been prevented?

Unfortunately, school is not the only forum for bullying. For instance, discontented workers have been reported to take revenge on coworkers and employers. Also, although not typically included in the media discussions of bullying, child and elder abuse can be considered as a form of bullying. In both child and elder abuse situations, there is a victim and a tormentor. However, these victims are usually unable to speak up or defend themselves. Both the very young and the very old lack a voice to ask for help, and may not have the means to inform others or fight back. Children have a slight advantage over the elderly in that they are usually protected by schoolteachers, friends' parents, nannies, pediatricians and other adults who, if they are looking, may spot signs of abuse. Child abuse also gets frequent airtime, which helps to increase public awareness of what signs of abuse to look for and when and how to get help.

Elder abuse, however, is typically more clandestine and, unfortunately, not often looked for or recognized. Elders are typically confined to their house or a nursing home and due to their physical and/or mental incapacity, the elder victim may technically be imprisoned.

Elder abuse can occur when grown children, their spouses or caregivers take advantage of the victims' compromised situations. Elder abuse results from many factors including self-pity by the caregivers, an unchallenged power play for control, retaliation for perceived past abuses, etc. etc. etc. Any weak and frail individual who is not able to fight back physically or is afraid to fight back because of potential financial retaliation may become an elder abuse victim.

Physicians are taught the signs of elder abuse -- e.g., multiple bruises, multiple fractures at different stages of healing, fractures that are reported to have occurred by an implausible mechanism of injury, a patient afraid or fearful to explain how the injuries occurred, etc. Many of these same injuries can truly result from weak bones, multiple falls secondary to instability and other non-abuse causes, so care must be taken to assure that abuse is not inappropriately diagnosed. However, even though an underlying abusive situation may not be definitive, the possibility should be entertained in specific circumstances.

The message is, bullying can happen in various forums and to individuals of all ages. Those without a voice, children, teenagers, the physically and mentally challenged, the shy and timid, are all vulnerable and need protection. As a civilized society, we must protect those not capable of protecting themselves. We need to look out for one another. Familiarity with signs of bullying and abuse is necessary. Awareness of the possibility of abuse is required and paramount for prevention. So, to answer the standard media questions of "Could this have been predicted?" and "How might this have been prevented?" -- the answers are that we must be aware that abuse and bullying can happen so it is important to look for signs, take action, speak up when appropriate, get help, and report it when indicated.

For more by Helene Pavlov, M.D. click here.

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