Two decades ago, in a pioneering study, the Canadian psychiatrist John Tillmann demonstrated that drivers with a record of repeated automobile accidents did not confine their "accident" behavior to the highway. They were—to a substantially greater extent than accident-free drivers— "in trouble" in various aspects of their lives. Their records in a variety of social and legal agencies documented widespread pathology—economic, social, psychological, physical.
Tillmann's conclusion, "You drive as you live," has achieved wide currency, but it has taken almost two decades for his conceptual framework to be applied to nonvehicular accidents—and especially to childhood accidents. Where such attempts have been made—where the investigator has broadened his focus on the "mechanics" of the accident to include a view of the personal and social characteristics of the individuals involved—the findings have been striking. Waller's unpublished study of shooting accidents demonstrates, for example, that those who have such accidents are quite different from gun owners who are accident-free. The paper that follows demonstrates some significant differences between mothers suspected of physically abusing their children and mothers of children whose accidents do not involve the suspicion of abuse.
Perhaps because the early, largely discredited, concept of "accident proneness" was fundamentally a psychological one, there remains a tendency in many investigators to seek out psychological characteristics that distinguish child-abusing parents from those who do not abuse their children. Since the significant distinguishing psychological variables usually involve unusual sensitivity to social stresses or a general deficiency in coping ability, a remedial program may attempt either psychotherapy of the individual or a general alleviation of the social stresses. The social approach offers a practical alternative to the cost and uncertainty of the psychotherapeutic approach.
Social determinants of health associated with childhood accidents at home: An integrative review
