The Misuse of Abuse: Restricting Evidence of Battered Child Syndrome
THE MISUSE OF ABUSE: RESTRICTING EVIDENCE OF BATTERED CHILD SYNDROME
KIP NELSON 0 1
0 Copyright © 2012 by Kip Nelson. This article is also available at
1 Associate, Smith Moore Leatherwood LLP; J.D., LL.M., Duke University School of law; B.S., Brigham Young University. The author expresses gratitude to all those who provided commentary on earlier versions of this article and especially to Professor Doriane Coleman for her critical feedback. 1. David Bakan, Slaughter of the Innocents: A Study of the Battered Child Phenomenon , 10 J. SOC. DISTRESS & HOMELESS 147, 154 (2001). 2. Jessica L. Hart & Jeffrey L. Helms, Factors of Parricide: Allowance of the Use of Battered Child Syndrome as a Defense, 8 AGGRESSION & VIOLENT BEHAV. 671, 680 (2003). 3. See infra Part II.A. 4. See infra Part II.A
syndrome may also be defined to include the profound psychological effects of
abuse.5 In order to determine the intentionality of the injuries, the repetitive
nature of child abuse is often a particularly important aspect of BCS.6
However, the original definition of the syndrome has not been closely
adhered to in all cases. Thus, for all the good it can do, the introduction of BCS
evidence in some cases is also rife with peril. As one student commentator
described it, BCS evidence “is a weapon capable of mischief.”7 In particular,
when BCS is used by prosecutors to mask otherwise impermissible and
prejudicial character evidence and by defense attorneys as a justification for
homicide, one should worry about its admissibility into the judicial system. In
these cases, lawyers have improperly shifted the focus of BCS from the abused
child to the person who is alleged to have caused the abuse. Because
prosecutors and defense attorneys are distorting BCS and obfuscating its role in
medicine, judges should take care to limit testimony regarding BCS to facts
about the abuse itself rather than the abuser.
THE HISTORICAL EVOLUTION OF THE BATTERED CHILD SYNDROME
Child abuse has occurred everywhere for centuries, albeit under different
levels of approval.8 In the West, philosophers such as Aristotle suggested that
killing defective children was wise, and Roman law gave fathers ultimate
command over their children, including control over life and death.9 Parents in
the eighteenth century went so far as to maim their children so that they could
become lucrative beggars or circus exhibits.10 Even into the twentieth century,
child abuse was generally an unrecognized trauma.11
In 1962, Dr. C. Henry Kempe and his colleagues published a seminal article
on child abuse and introduced the term “battered child syndrome.”12 Kempe
used the term to describe “a clinical condition in young children who have
received serious physical abuse, generally from a parent or foster parent.”13
Kempe recognized physicians’ reluctance to consider abuse as the cause of a
child’s injuries.14 But he admonished them that “[t]o the informed physician, the
bones tell a story the child is too young or too frightened to tell.”15 Based on this
recognition, Kempe argued that “the physician’s duty and responsibility to the
child requires a full evaluation of the problem and a guarantee that the
expected repetition of trauma will not be permitted to occur.”16 Such a
recognition created implications for both medicine and law.
A. BCS in Medicine
As originally intended, BCS was a way for medical professionals to identify
abuse in children. Kempe recognized that the nature and degree of injuries
resulting from abuse vary widely,17 and that the typical abusive caretakers
initially exhibit “complete denial of any knowledge of injury to the child.”18 Still,
he identified some tell-tale signs of repeated abuse that could reveal the lies in
the caretakers’ denials, including severe bruises, multiple fractures, and lesions
in different stages of healing.19 Consistent with these signs, Kempe proffered
radiologic examination as the primary vehicle to identify child abuse.20 Kempe
concluded that “a marked discrepancy between clinical findings and historical
data as supplied by the parents” is a major diagnostic feature of the BCS.21
Kempe’s classic description of BCS, however, proved to be too narrow. The
year following the publication of Kempe’s article, Dr. Vincent Fontana
criticized that narrowness and proposed the concept of “maltreatment
syndrome” instead.22 In addition to physical abuse, Fontana argued that the
syndrome should include such injuries as “deprivation of food, clothing, shelter
and parental love.”23 He persuaded even Kempe himself, who ultimately argued
that the label BCS be dropped in favor of the more general term “child abuse
Kempe’s work and views gained wide acceptance, particularly in the medical
and mental health professions. Since the publication of his original article,
understanding of child abuse has expanded greatly.25 Kempe and his colleagues
identified two principal components of the syndrome: physical manifestations
and psychiatric aspects.26 Thus, although many think of child abuse as a physical
condition, the breadth of BCS has “slowly evolved from a purely medical term
to include the . . . psychological effects of abuse.”27
Current research focuses on identifying both physical abuse and its
term effects. Medical professionals use modern technologies, including
biomechanics, proteomics, biochemistry, and genetics, to detect the physical
aspects of child abuse.28 In this context, BCS is still often diagnosed as a result of
signs of repeated abuse, particularly in bone injuries.29 Doctors can analyze both
radiological and histological findings to date fractures found in children.30
Dating fractures can show both repetition of injuries and indicate if the injuries
developed in accordance with the parent’s version of how the trauma occurred.
The physical effects of child abuse are relatively straightforward, even when
they lurk beneath the skin. The psychological and developmental effects,
however, are not as clear or easy to discern.31 For example, the mental
consequences of child abuse are said to include depressive and anxiety
disorders.32 Research has also associated child abuse with some psychosomatic
behaviors, including nicotine and marijuana use,33 obsessive–compulsive acts,34
and HIV risk behaviors.35 Yet, the psychological contours of the syndrome
remain unclear—research has not definitively fit BCS within any specific
Kempe used the name of the syndrome as a shorthand device to describe a
previously unrecognized set of injuries; contemporary medical and mental
health professionals use BCS as a convenient description of intentional abuse.
But diagnosing BCS is not always clear cut. One researcher has indicated that
“oversensitivity or hyposensitivity of the children to the pain, insufficient
history to the explanation of the trauma’s features, the time between the
approval of the patient for physical examination and trauma’s exact time may
lead us to the diagnosis of battered child syndrome.”36 BCS was never intended
to be an illness in the sense of a disease that doctors could label, research, and
cure. As a result, researchers have not concerned themselves with efforts to
carefully limit the syndrome. They even recognize that not all abused children
have BCS.37 Indeed, the syndrome is what a medical dictionary says a syndrome
is: “[A] set of symptoms that occur together.”38
As child abuse remains a major social problem,39 however, the increasing
research maintains continued importance. The National Child Abuse and
Neglect Data System reported that in 2006, social service agencies found
905,000 children in the United States to be survivors of child abuse or neglect.40
To give some perspective to the statistic, the international incidence of child
abuse is ten times more common than cancer.41
B. BCS in the Law
Of course, child abuse occurred and was recognized as such before Kempe’s
article. Even historical texts such as the Bible include prohibitions against
infanticide.42 Still, modern prosecutions for child abuse were virtually
nonexistent well into the nineteenth century.
Then, in 1874 the plight of one eight-year-old girl gained national attention.
For several years, Mary Ellen Wilson was neglected, abused, and starved by her
guardian.43 When the caretaker was convicted of what the judge referred to as
“gross and wanton cruelty,”44 the case became one of the first successfully
prosecuted child abuse cases in the United States.45 Although the Society for the
Prevention of Cruelty to Animals officially initiated Mary Ellen’s case, the
Society for the Prevention of Cruelty to Children formed quickly thereafter.46
Since then, criminal prosecutors have been increasingly aware of the child
With the advent of Kempe’s work on BCS, child abuse became a widely
recognized phenomenon in the law. Within four years of the publication of
Kempe’s article, the vast majority of states passed statutes to address child
abuse.48 Largely because of Kempe’s suggestion that a physician “should report
possible willful trauma to the police department or any special children’s
protective service that operates in his community,”49 all states currently have
laws that require certain individuals to report suspected abuse to law
enforcement.50 These reporting requirements are at the core of a comprehensive
legal scheme that is, among other things, designed to identify abused children
and prosecute their abusers.
However, child abuse cases, and especially homicides, can be very difficult
to prosecute because of a lack of evidence. For example, even if the victim is
alive, he or she may be too young to testify or too immature to be credible.51
Without direct evidence, prosecutors turn to BCS because “the bones tell a
story the child is too young or too frightened to tell.”52 Therefore, “[d]espite
defendants’ objections, courts have repeatedly admitted [BCS] evidence
claiming that battered child syndrome provides proof of intent and negates
accident in relevant cases.”53 When direct evidence in abuse cases is lacking,
prosecutors use BCS to show a history of abuse and indicate that someone
intended to cause harm.
In its correct form, evidence of BCS is properly admissible as medical
testimony. For example, the case of State v. Wilkerson54 involved a two-year-old
child, Kessler Wilkerson, who was first abused and then killed by his father.
Kessler suffered multiple injuries over the course of his short life, ranging from
standing “spread eagle” for long periods of time to violent kicks in the
abdomen.55 Kessler’s father explained to a neighbor that he wanted to “bring
[Kessler] up to be a man.”56 Eventually, Kessler died of an abdominal
hemorrhage from a ruptured liver.57 His father claimed that Kessler choked on
his cereal and swallowed some water, but the doctors found no fluid in the
child’s lungs or any signs of drowning.58 The father was convicted of
seconddegree murder,59 based partly on the testimony of a pediatrician on BCS.
At trial, the pediatrician defined a battered child as one “who died as a
result of multiple injuries of a non-accidental nature.”60 Although he explained
the medical evidence that resulted in his conclusion that Kessler Wilkerson was
a battered child, the doctor did not attempt to identify or describe the particular
individual who would have caused such injuries. Instead, the pediatrician’s
testimony focused on injuries he had witnessed in similar children and
50. SAMUEL M. DAVIS ET AL., CHILDREN IN THE LEGAL SYSTEM: CASES AND MATERIALS 559
(4th ed. 2009).
51. Sagatun, supra note 29, at 201. For additional evidence on the difficulty of proving child abuse
in court, see Jack G. Collins, The Role of the Law Enforcement Agency, in THE BATTERED CHILD,
supra note 8, at 179, 183.
52. Kempe et al., supra note 11, at 18.
53. Baldwin, supra note 7, at 66.
54. 247 S.E.2d 905 (N.C. 1978).
55. Id. at 908.
57. Id. at 907.
59. Id. at 919.
60. Id. at 908.
explained how they related to the situation in Wilkerson.61 The Supreme Court
of North Carolina ruled that the pediatrician’s testimony was properly admitted
because it did not invade the province of the jury since it was helpful to explain
something that the jury would not otherwise understand.62 Furthermore, the
testimony was based solely on the doctor’s experience with abused children.63
Conversely, the court noted that such evidence would likely be inadmissible if
the expert testified “that a certain event had in fact caused the injuries
complained of.”64 The latter would not only have been beyond his medical
expertise, it would have also served to bring Kessler’s injuries home to the
defendant. Based on the proper evidence of previous injuries, Wilkerson was
On the other hand, evidence of past abuse has not received universal
acceptance. In United States v. Diaz,65 for example, an expert witness presented
a pattern of abuse against the defendant’s two infant daughters.66 The Court of
Appeals for the Armed Forces referred to such evidence as “uncharged
misconduct” and held that it was inadmissible to demonstrate a pattern of
abuse.67 The doctor’s testimony regarding previous injuries was not relevant
because the prosecution did not present sufficient evidence to establish the
defendant’s culpability for those injuries.68 The court expressed “grave doubt
that the panel could separate and fairly consider the uncharged and charged
misconduct. Under the prosecution’s theory, these events of uncharged and
charged misconduct were inextricably intertwined.”69
Therefore, BCS is apparently relevant, reliable, and admissible evidence if it
focuses on Kempe’s original definition: “[A] clinical condition in young children
who have received serious physical abuse.”70 Consistent with evidence law, as
medical and mental health professionals study child abuse, they should be able
to testify in court so long as their information is relevant and not more
prejudicial than probative.71 Therefore, as in Wilkerson, courts have generally
held that BCS evidence is admissible for the purpose of describing prior
injuries.72 Using the syndrome in that sense falls precisely within Kempe’s
original definition, and will subsequently be referred to as “Kempe’s BCS.”
Legal use of BCS evidence has evolved to be something more than Kempe’s
BCS, however. Indeed, according to one scholar, “[t]he recent tendency has
been to broaden the definition of child abuse as a medical phenomenon, which
in turn has resulted in a broadening of its definition . . . under the law.”73 One
doctor, for example, testified that BCS is “a general term used to describe any
kind of abuse or neglect to a child in the first three years of his life; the
syndrome may arise from sexual, emotional, physical or nutritional abuse.”74
Even if that definition is an accurate statement of its evolution and helpful in
the medical context, the doctor’s definition creates grave problems when used
Lawyers on both sides of the case have morphed Kempe’s BCS into what is
essentially a “child batterer syndrome.” Prosecutors use related evidence to
show that a defendant is the type of person who would abuse a child. Some
have extended it so far as to provide for a child battering profile. Conversely,
parricide defendants use it to show that their victims, who are alleged to have
abused their children, “deserved” their punishment. In either case, Kempe’s
BCS is stretched far beyond its original usefulness as such judicial uses of BCS
taint the original purpose of the syndrome and obfuscate its importance.
A. Child Batterer Syndrome
Prosecutors use the syndrome as a convenient description of child abuse as
well as the child abuser. For example, Tori McGuire was a six-month-old girl
who died forty-five minutes after being brought to the hospital by her parents.75
Her father, Mark McGuire, was subsequently convicted of second-degree
murder for her death, based partly on the testimonies of two physicians who
stated that the victim was a battered child.76 Although both doctors concluded
that the child exhibited signs of the syndrome, their definition of the syndrome
was very general: “[A] group of findings which when combined indicate that
[the] child had died as a result of mistreatment from another person, usually an
72. See, e.g., Price v. Commonwealth, 446 S.E.2d 642, 644, 645–46 (Va. Ct. App. 1994) (explaining
that BCS evidence is permitted when limited to description of previous injuries and the testifying
doctor “expressed no opinion as to the identity of the abuser”); see also People v. Cauley, 32 P.3d 602,
604–06 (Colo. App. 2001) (employing similar logic to approve evidence of shaken baby syndrome).
73. DAVIS ET AL., supra note 50, at 535.
74. United States v. Bowers, 660 F.2d 527, 529 (5th Cir. 1981).
75. Estelle v. McGuire, 502 U.S. 62, 64–65 (1991).
77. Brief for Petitioner at 11, Estelle v. McGuire, 502 U.S. 62 (1991) (No. 90-1074), 1991 WL
The evidence of prior abuse was relatively similar to that presented in
Wilkerson. The use of the evidence presented against McGuire, however, was
not the same use of similar evidence against Wilkerson. Evidence in the
McGuire case was properly presented, per the Wilkerson line of reasoning, that
the victim had multiple bruises, rectal tearing that was at least six weeks old,
partially healed rib fractures, and other injuries at different stages of healing.78
Evidence was also presented that Tori’s mother was the person who inflicted
the fatal injury.79 The only evidence connecting McGuire to the injury that
caused Tori’s death was the fact that he was at home during the relevant time
period.80 Evidence was presented, however, that McGuire had treated Tori
roughly in the past.81 Thus, the prosecutor focused on the previous abuse and
went beyond Kempe’s BCS when he “argued that the modality of violence
identified McGuire as the killer.”82 In essence, “McGuire was on trial for his
propensity for violence, rather than for whether he committed the murder of his
The trial judge exacerbated the problem by explicitly linking McGuire to
the previous injuries. “Evidence has been introduced,” the judge told the jury,
“for the purpose of showing that the Defendant committed acts similar to those
constituting a crime other than that for which he is on trial.”84 If anything could
have sealed McGuire’s fate, the judge certainly provided it. McGuire appealed
his conviction, arguing that the jury had “the mistaken impression that it could
base its finding of guilt on the simple fact that he had previously harmed [the
victim].”85 The state courts upheld the conviction, but the Ninth Circuit reversed
the conviction on federal habeas review.86
The Supreme Court finally reached the BCS issue in Estelle v. McGuire.87 In
a six–two decision,88 the majority upheld the conviction upon McGuire’s habeas
petition, holding that “McGuire’s due process rights were not violated by the
admission of the evidence.”89 The BCS evidence was permissible because it was
“probative on the question of the intent with which the person who caused the
By so holding, the Court failed to recognize that the use of BCS in Estelle
was far from what Kempe had intended. Despite the evidence that McGuire’s
wife had actually caused the fatal injury, McGuire was convicted because of
BCS evidence. Instead of explaining who committed the charged crime, the
prosecutor told the jury that McGuire had abused the child in the past.91 Thus,
even without using the language of a profile, McGuire was labeled as one who
abused children and thus was likely the cause of his daughter’s death.92 The
prosecutor turned Kempe’s battered child syndrome into child batterer
syndrome. Such evidence is much closer to the impermissible profile evidence
described below than the admissible BCS evidence described in Wilkerson.
Indeed, some of the judges involved in Estelle seemed more upset by the
prior history of abuse than the injury that actually caused the child’s death.
Judge Kozinski, dissenting from the Ninth Circuit’s denial of the state’s petition
for en banc rehearing, gave a detailed and explicit description of the prior
injuries—but not the fatal one.93 Rather than providing a thorough explanation
of his legal analysis, he summarily concluded that “McGuire got no worse than
Conversely, it was the original panel of Ninth Circuit judges who perceived
the situation correctly. “The prosecution introduced evidence of prior injuries
to the baby to establish that [McGuire] was a child abuser, and for no other
purpose, in a murder trial for the death of his child.”95 The panel further
explained, “we cannot ignore that a trial of the grisly murder of an innocent
baby implicates highly charged emotions. The unproven characterization of
appellant as a child abuser maximized the prejudice flowing from the irrelevant
Whatever its value in constitutional jurisprudence,97 the Supreme Court in
Estelle incorrectly decided the BCS question. Still, after the Court’s decision in
Estelle, prosecutors across the country have used BCS in the same way. Some
courts simply cite to Estelle to explain that BCS evidence was properly
admitted.98 The most recent cases do not even discuss its admissibility: they just
take it for granted.99 Because of Estelle, courts seem to have a green light to
allow the use of BCS evidence that goes far beyond a description of previous
injuries to prove that the injuries at issue in the case were not accidental.100 Such
a judicial extension of Kempe’s BCS creates several problems.
Those familiar with BCS would likely admit that this evidence does more
than “simply indicate[ ] that a child found with serious, repeated injuries has not
suffered those injuries by accidental means.”101 The prosecutor who uses BCS
really argues that because the defendant committed these acts in the past, he is
a child abuser who needs to be punished, almost regardless of whether he
actually committed the crime charged. Instead of focusing on the crime, the
evidence evolves from what the person did (or did not do) into who the person
is. Such evidence is dangerously close to a propensity argument, which
evidentiary rules generally prohibit.102 As reprehensible as the prior injuries are,
a fact finder is only permitted to punish a defendant for the crimes actually
Evidence of past similar acts is only relevant if the defendant in fact
performed the similar acts.103 Even if they donot hear this requirement
explicitly, jurors may be unable to parse the past behavior from the charged
crime. When jurors learn about the past injuries, they may be simultaneously
learning or feeling, even implicitly, that they need to punish someone for those
injuries. As in Estelle, the prosecution then focuses on previous injuries in part
to indicate to the jury who committed the crime in question. Thus, prosecutors
cleverly mask otherwise-impermissible propensity arguments with the guise of a
That masking problem is compounded when defendants must respond to the
evidence. “Vigorous cross-examination, presentation of contrary evidence, and
careful instruction on the burden of proof are the traditional and appropriate
means of attacking shaky but admissible evidence.”104 These means, however,
are certainly less effective if not impossible in child abuse cases. Once a
defendant is labeled as a child abuser, either explicitly or implicitly, any other
evidence will likely fall on deaf ears. Thus, when prosecutors use BCS evidence
to indicate who committed the previous injuries, those on trial are left to defend
themselves against an impenetrable attack.
On the other hand, the prosecutor paints a vivid and disturbing picture to
the jury. The nature of this type of BCS allows prosecutors to focus more on a
graphic description of previous abuse and less on the expert’s diagnostic or
classification criteria regarding the charged crime. For those listening to the
story unfold, “the vision of a child being tortured arouses the sense of weakness
510–11 (La. Ct. App. 1999) (same); State v. Taylor, 701 A.2d 389, 391, 395–96 (Md. 1997) (citing Estelle
and permitting BCS evidence that was presented to show the defendant’s intent and the absence of
mistake, although ostensibly not to show that he “was generally a bad person”).
101. Estelle v. McGuire, 502 U.S. 62, 68 (majority opinion) (quotations omitted).
102. FED. R. EVID. 404(b) (“Evidence of other crimes, wrongs, or acts is not admissible to prove the
character of a person in order to show action in conformity therewith.”).
103. Otherwise, the evidence would not be “of consequence to the determination of the action.” Id.
104. Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579, 596 (1993).
and vulnerability that each of us had as a child.”105 As opposed to Kempe’s BCS,
the prosecutor here uses evidence of the syndrome as a summation of why the
jury should punish the defendant.
In addition, experts testifying about the syndrome have exactly what the
Supreme Court feared with regard to polygraph evidence: the aura of
infallibility.106 “[T]he horrifying injuries of child abuse cases are inflammatory,
and one runs the risk that the jury will attach too great a weight to the prior
injury evidence.”107 Indeed, “[t]he potential to allow jury prejudice to lessen the
burden of proof is the very rationale for prohibiting character evidence under
the guise of ‘battering parent syndrome.’”108 Far beyond explaining Kempe’s
syndrome, prosecutors who use BCS in this way convince the jurors that the
doctors are sufficiently well informed to identify the perpetrator, even when
that is not what the doctors intend to say.
Finally, focusing on the previous injuries instead of the charged crime also
presents another problem. As one expert witness testified, “in eighty percent of
fatal child abuse cases, [the] fatal event is the first time that that child has ever
been abused.”109 Kempe’s BCS was intended to include not just a pattern of
abuse but also single occurrences. But prosecutors who are focusing on this type
of BCS may be missing, and therefore misrepresenting, the bigger picture.
The current use of BCS evidence by prosecutors is, therefore, unfairly
prejudicial. Regardless of the heinousness of the previous abuse, those injuries
are not what put McGuire or similar defendants on trial. The use of BCS
evidenced in Estelle is not the same as Kempe’s BCS. And prosecutors should
not be permitted to use a medical syndrome such as BCS to relieve their burden
of proving beyond a reasonable doubt who committed the crime in question.
B. Child Battering Profile
In a similar vein, prosecutors have also attempted to use BCS to create a
battering person profile. When a child abuse prosecution is weak enough, such
use of expert testimony is employed to describe the type of person who would
abuse a child. Some traditional characteristics of such a profile include stress in
the family, violence against other family members, and isolation.110
Fortunately, courts have generally held such testimony to be inadmissible.
In Commonwealth v. Day, for example, the defendant had apparently abused
his victim several times while living with the victim’s mother.111 The victim, an
eighteen-month-old girl, had “several contusions on her head, neck, abdomen,
105. Bakan, supra note 1, at 157.
106. United States v. Scheffer, 523 U.S. 303, 314 (1998).
107. Baldwin, supra note 7, at 69.
108. State v. Aguayo, 835 P.2d 840, 847 (N.M. Ct. App. 1992) (granting a new trial because of prior
abuse evidence, although not specifically labeled as BCS).
109. United States v. Traum, 60 M.J. 226, 231–32 (C.A.A.F. 2004).
110. Commonwealth v. Day, 569 N.E.2d 397, 398 (Mass. 1991).
kidney, legs, and feet.”112 Eventually the beatings became more severe, and the
child tragically died from “blunt trauma to the head and neck.”113
Still, the major distinction from Wilkerson lies not in the facts but in the use
of expert witnesses. Rather than focusing on the child’s previous injuries, the
prosecutor forced the expert witness in Day to spend the majority of his
testimony on certain characteristics of the typical family in which abuse
occurs.114 The court, however, held that “[e]vidence of a ‘child battering profile’
does not meet the relevancy test, because the mere fact that a defendant fits the
profile does not tend to prove that a particular defendant physically abused the
victim.”115 Because the prosecutor focused on the person doing the battering
rather than the child being battered, the evidence was inadmissible.116
Indeed, despite the fact that the situations occurred on opposite coasts, the
similarities between Day and Estelle are striking. In both cases a little girl under
the age of two tragically lost her life. In both cases it was a man accused of
killing a child. In both cases the defendants presented evidence that the child’s
mother not only had access to the child but also was likely culpable herself.
Doctors found extensive sets of bruises and injuries on both children. Yet,
although both cases reached a supreme court, the outcomes were very different.
As in Day, the Ninth Circuit has hinted that battering profile evidence is
improper. In Martineau v. Angelone, a doctor diagnosed the victim as having
BCS despite the absence of any “signs of previous abuse or neglect.”117 The
court suggested that the prosecutor should not have had the doctor testify
regarding the diagnosis in the first place.118 Indeed, the prosecutor’s use of the
doctor’s “opinion was based on an abstract theory of how child abusers
behave.”119 Fortunately, courts have generally recognized that the use of such a
child battering profile is improper.
Furthermore, current evidentiary rules show a general policy judgment that
profile evidence is improper in the courtroom. “In general, courts have found
any kind of ‘profile testimony’ to be unreliable.”120 “The use of criminal profiles
as substantive evidence of guilt is inherently prejudicial to the defendant.”121
Even more importantly, BCS presents differing profiles. The typical families in
which abuse occurs are “anomic and alienated, virtually isolated, without
friends or interested relatives, without religious affiliation, and without any club
or group membership or association.”122 Other research explains that one who
abuses a child “often suffered abuse as a child, ha[s] a low intelligence level, and
lack[s] maturity.”123 Whereas researchers attempt to create a comprehensive
picture of a battered child, prosecutors use BCS to create a problematic set of
C. Defensive Use of BCS Evidence
On the other side of the courtroom, defendants also raise the issue of child
abuse, but as a justification for homicide, particularly of abusive parents. For
example, after years of physical and psychological abuse, Deborah Jahnke
assisted her brother in fatally shooting their father.124 Jahnke was subsequently
convicted of aiding and abetting voluntary manslaughter.125 The ensuing Jahnke
v. State was the first case in which a defendant argued that killing an abusive
parent is justified as a form of self defense. Naturally, similarly situated
defendants quickly gravitated to the BCS defense.126
Perhaps the most widely publicized case of BCS evidence as a defense was
the trial of the Menendez brothers. In 1989, Erik and Lyle Menendez shot and
killed their allegedly abusive parents.127 After the brothers’ first trial resulted in
deadlocked juries, the brothers were retried and the defense called Dr. John
Wilson as an expert witness.128 Dr. Wilson expressed his opinion that Erik
Menendez suffered from what the doctor called “battered-person’s
syndrome.”129 Although Dr. Wilson proceeded through a lengthy description of
a diagnosis for post-traumatic stress disorder, he merely acknowledged the
existence of battered person’s syndrome without further explanation. The
closest thing to a definition of the syndrome, notably supplied by the defense
attorney rather than the witness, was “persons who have certain symptoms and
report a relationship with another person which has traumatizing features.”130 In
addition, Dr. Wilson clarified that many people with battered person’s
syndrome do not have post-traumatic stress disorder. Dr. Wilson described the
current research situation as an “ongoing revolutionary process.”131
Although the use of this testimony was ultimately unfruitful (as Erik
Menendez was still convicted), it presents a disturbing trend in judicial use of
BCS evidence. The defense lawyer’s use of Dr. Wilson’s testimony is a far cry
from Kempe’s original definition of the syndrome. Nowhere in the Menendez
trial did the attorney have the doctor describe the injuries themselves or explain
how he reached his conclusion that the brothers had battered person’s
syndrome. As with most cases of this type, the defense attorney simply used
BCS as a convenient route to present his testimony. Such a defensive use of
BCS creates problems of its own.
In contrast to the prosecutorial use of BCS, the evidence is intended to be
character evidence when criminal defendants use it in homicide prosecutions as
a form of self defense. Use of expert testimony in that situation “demands that
the jury consider the defendant’s reactions not as a ‘normal’ person, but as [a]
battered child.”132 In other words, the childhood “he made me do it”
justification reverberates again in the courtroom. As with prosecutorial
evidence, though, this type of evidence is improper.
Using battered child syndrome as a justification contradicts the basic theory
of self defense. Normally, self defense requires a reasonable fear of imminent
harm.133 The classic case of self defense is when a homicide victim starts the fight
that ends in his or her death. However, empirical research has shown that the
defendants who use BCS as a defense usually use unreasonable force, kill while
the victim is in a relaxed position, and act out of personal vengeance rather than
self protection.134 To further cast doubt on the validity of the BCS defense, “the
abuse often remains concealed until trial; this leaves many to conclude that the
defendant has concocted an ‘abuse excuse.’”135
As with prosecutorial experts, defense experts may have an aura of
infallibility. Such experts could disguise the actual issue in a homicide case and
prevent the jury from truly analyzing the defendant’s culpability. As Dr. Bakan
noted, “Explanation can function as excuse; and when the evil is so monstrous
we do not tolerate the possibility that it is excusable.”136 When defense attorneys
use expert witnesses to explain that defendants cannot be guilty if they exhibit
signs of BCS, the judicial system struggles to maintain its focus on holding
people responsible for their actions.
Not all courts approve of this defensive use of BCS.137 And this discrepancy
creates a larger problem, as well. “[W]hen [the evidence] is allowed, the
children often are acquitted, and where it is refused, they are usually convicted,
despite the fact that the children are similarly situated.”138 Defendants who find
a friendly judicial ear and are able to use such a broad definition of BCS thus
have a significant advantage
Still, the problem looms larger than one might think. A federal circuit court
132. Baldwin, supra note 7, at 76.
133. See, e.g., United States v. Ebert, 294 F.3d 896, 898 (7th Cir. 2002).
134. Hart & Helms, supra note 2, at 677–78.
135. Baldwin, supra note 7, at 78.
136. Bakan, supra note 1, at 151.
137. See, e.g., State v. Crabtree, 805 P.2d 1 (Kan. 1991); Jahnke v. State, 692 P.2d 911 (Wyo. 1984).
138. Baldwin, supra note 7, at 81.
of appeals has implicitly approved of a BCS defense.139 State courts seem to be
moving in the same direction.140 The law is slowly replacing Kempe’s BCS with a
new version of the syndrome that takes the focus away from the battered child
and onto the battering parent.
Because of these various extensions, states have disagreed on the
admissibility of BCS evidence. Some legislatures have passed statutes to address
the admissibility of such evidence. In 1991, for example, Texas enacted the first
law that allows a person who has been accused of killing his parent to admit
evidence of past abuse.141 At least four states specifically allow experts to testify
about BCS in various situations.142 Conversely, some states specifically preclude
the defensive use of BCS evidence altogether.143 Other state statutes are simply
silent on the issue.
Likewise, courts struggle with the current uses of BCS evidence. The
Supreme Court of Ohio, for example, ruled that the evidence is generally
admissible when it is relevant and reliable.144 Some courts say that BCS evidence
is admissible because the syndrome is an accepted medical diagnosis;145 others
say that the evidence is permissible as simply a sociological term.146 Conversely,
the Kansas Supreme Court determined that the evidence is inadmissible, at
least when the killing does not involve a specific precipitous confrontation.147
Still, some general trends have emerged. Although courts have frequently
permitted evidence of battered child syndrome to prove the intent to commit
child abuse, courts rarely allow use of the syndrome as a defense to prove
justification.148 Judges have generally come to a consensus that expert witnesses
may give testimony on descriptions of commonly observed behaviors.149 Courts
also agree “that the expert cannot testify in the form of legal conclusions as to
whether abuse occurred and, if so, who committed the abuse.”150
THE PROBLEM AND ITS SOLUTION
The current use of BCS creates a unique problem in the courtroom because
of its amorphous nature in the hands of clever attorneys. The flexibility of
Kempe’s BCS is one of its principal benefits, but that same flexibility is actually
a hindrance to the fact-finding process when lawyers use expert witnesses to
explain such a novel concept to lay jurors without concrete terms. Furthermore,
the common thread among the three mutations of BCS evidence is that they
take the focus away from the child’s injuries and onto the person causing those
injuries. Thus, the use of evidence beyond Kempe’s original definition morphs
BCS into a behavioral, rather than a physical, syndrome. Identification of
typical behavior is not the same as identification of physical injuries.151 True
BCS evidence, or in other words Kempe’s BCS, “seeks to explain physical
injuries, rather than behavior.”152 Yet, all of the versions of BCS described
above focus on the perpetrator’s behavior.
The problem with such an extension of BCS evidence is twofold. First, the
use of such evidence is on shaky ground under general rules of expert
testimony. Second, and perhaps more importantly, such use of BCS tends to
diminish the syndrome’s importance in the medical field. As a solution, judicial
use of such evidence should be strictly limited to Kempe’s BCS.
A. Analyzing the Current Uses of BCS Evidence
The Supreme Court dramatically changed the analysis of expert testimony
in 1993. Daubert v. Merrell Dow Pharmaceuticals, Inc.153 disbanded the
prevailing general acceptance standard as the test for such evidence. The Court
noted that expert testimony requires “a valid scientific connection to the
pertinent inquiry as a precondition to admissibility.”154 In determining the
admissibility of expert testimony, the Court instructed future judges to consider
such factors as whether a scientific theory can be (and has been) tested, whether
it has been subjected to peer review and publication, the known or potential
rate of error, the existence and maintenance of standards controlling its
operation, and its general acceptance within the relevant scientific community.155
The purpose of this new analysis was to ensure that “any and all scientific
testimony or evidence admitted is not only relevant, but reliable.”156
The advisory committee subsequently changed the Federal Rules of
Evidence to reflect the Daubert holding. Now, the Rules explain that an expert
witness may opine only under limited conditions: “if (1) the testimony is based
151. See State v. Lopez, 412 S.E.2d 390, 393 (S.C. 1991) (distinguishing evidence of a behavioral
syndrome from evidence “based on a number of physical findings”).
152. Brodit v. Cambra, 350 F.3d 985, 991 (9th Cir. 2003).
153. 509 U.S. 579 (1993).
154. Id. at 592.
155. Id. at 593–94.
156. Id. at 589.
upon sufficient facts or data, (2) the testimony is the product of reliable
principles and methods, and (3) the witness has applied the principles and
methods reliably to the facts of the case.”157
Several states have not yet adopted the Supreme Court’s Daubert analysis.158
Of those that have, only two states have specifically applied a Daubert analysis
to BCS.159 Both courts held that the BCS evidence was admissible, but neither of
the courts addressed the Daubert factors in particular. A lawyer’s extension of
BCS, as opposed to Kempe’s version, does not lend itself to sufficient
testability, rate of error, standards of maintenance, peer review, or general
acceptance. A proper analysis of these Daubert factors shows that the current
use of BCS does not pass the Supreme Court’s standard.
Like any scientific evidence, the use of BCS should be tested for relevance
and reliability before it is deemed admissible. As a syndrome, judges have
naturally compared BCS with other syndromes. The Supreme Court of
Washington, for example, ruled that BCS evidence is admissible because it is
the “functional and legal equivalent of the battered woman syndrome.”160
Similarly, the Minnesota Supreme Court explained that “[l]ike expert testimony
on battered woman syndrome . . . expert testimony on battered child syndrome
may help to explain a phenomenon not within the understanding of an ordinary
lay person.”161 Of course, the admissibility of other syndromes is an ongoing
debate.162 However, BCS is not necessarily like other syndromes. Indeed, one
doctor explained that “a set of symptoms has not been shown in battered
children at a sufficient rate of occurrence to support the same general
acceptance in the community that battered woman syndrome enjoys.”163 Judges
need to do an independent analysis of BCS, and its specific use in the case at
hand, before it is admitted into evidence.
Because the current use of BCS is a description of several ambiguous
symptoms, which change depending on who is using the evidence, it cannot be
“tested” in the traditional sense. Researchers recognize that not all physically
abused children suffer from BCS.164 However, they have not delineated a clear
description of when BCS exists and when it does not. Neither The Diagnostic
and Statistical Manual nor The International Classification of Diseases contains
diagnostic criteria for BCS. Since no diagnostic criteria are in place, nobody can
argue with the lawyer’s application of the syndrome in a specific situation. Most
starkly, neither the law nor medicine can effectively test Dr. Wilson’s definition
of battered person’s syndrome since so many people have relationships “with
Differential diagnosis is particularly difficult in suspected abuse cases,
especially because alternative explanations exist for most common injuries in
child abuse.165 Even bruises, perhaps the most easily recognized sign of physical
abuse, can be attributed to other causes, such as leukemia, coagulation
disorders, or connective tissue disorders,166 not to mention accidental injuries.
When prosecutors use BCS to identify the perpetrator of previous injuries, like
the evidence presented in Estelle, they often forget these simple facts. Contrary
to courts’ assertions that BCS is an accepted diagnosis,167 forensic experts have
yet to create a specific set of symptoms with which they can test the syndrome.
As one judge explained, “[T]here is no acceptable scientific method yet
applicable to the syndrome.”168
Consequently, the current uses of BCS have no known or potential rate of
error. However, judges should remember that “[m]any of the so-called common
effects of abuse may be attributed to other trauma or exist in normal
children.”169 The Supreme Court of Minnesota has explained that “in the area of
‘syndromes’ experts do not administer a specific set of tests.”170 Child abuse is
certainly a serious problem that society needs to address and curtail, but by
extending it beyond Kempe’s definition, the judicial use of BCS has failed to
present any known or potential rate of error.
Researchers have also recognized that no definitive standards for identifying
these modifications of BCS exist. Some will concede that the line between
punishment and abuse “may be quite thin psychologically.”171 The research has
not, and probably cannot, draw a bright line between child rearing and child
abuse. Indeed, physicians faced with an abuse situation would likely not even
want to draw such a line. Yet, proposed standards for admissibility in court are
likewise unworkable. For example, one researcher has suggested that “[t]he
defense of battered child syndrome would still be reserved for only those cases
where there is clear evidence that the defendant acted out of desperation and
had no other choice.”172 However, deciding ex ante which cases have clear
evidence of desperation is an all-but-impossible task for a court unless it has a
comprehensible definition of BCS to follow. Limiting the syndrome to Kempe’s
syndrome gives just such a definition.
Furthermore, researchers have not sufficiently published or peer reviewed a
clear description of BCS in the way it is currently used by prosecutors and
defendants. Those in the medical field still recognize a significant lack of
research.173 Researchers have studied and identified child abuse, but they have
not introduced a body of research defining or limiting BCS. Particularly when
considering defendants seeking to use BCS evidence as part of a self-defense
argument, violence against parents is arguably the most under-researched form
of family violence.174 To add to the problem, the American Board of Pediatrics
did not administer the first examination for board certification in child abuse
pediatrics until 2009.175 Under Daubert, judges should not permit lawyers to use
testimony that is in advance of current research.
Although BCS has certainly and rightly gained a level of general acceptance,
its specific boundaries have not. Reactions of victims to abusive behavior vary
widely, and that variance prevents the formation of any established or agreed
upon observable indicators of an abused child profile.176 A psychologist noted
that the research is “inconclusive at best, dubious at worst, and undeniably
contradictory.”177 Unfortunately, doctors who provide expert testimony on child
abuse do not always receive a favorable response from the media or from the
public.178 Although the type of BCS used in courts may have gained a general
acceptance among attorneys, it has not necessarily gained the same acceptance
among those who are experts in the field. Kempe’s BCS is generally accepted
among medical and legal practitioners, but the extensions described above are
less established. Particularly with respect to its psychological components, BCS
“is not, at this point, well tested and confirmed enough to gain credibility that
there is such an accepted syndrome.”179
Finally, the Federal Rules of Evidence explain that expert opinion is only
admissible if the witness “has applied the principles and methods reliably to the
facts of the case.”180 Courts, however, seem to take a different view. The
Minnesota Supreme Court, for example, explained that BCS experts cannot
testify about whether a particular person has the syndrome.181 Yet, the court
also recognized that the evidence is only relevant if the attorneys establish a
factual basis to suggest that the person actually has the syndrome.182 Although
the expert witness ostensibly cannot say that a specific person has BCS, the
evidence is only admissible if the person does. Indeed, some states only allow
evidence of previous abuse if that connection is actually proven.183 By taking the
focus away from medical testimony and onto personal attacks on character, the
current use of BCS violates these admissibility tests for scientific evidence.
Conversely, Kempe’s BCS does not suffer from these same weaknesses.
Perhaps Kempe’s BCS cannot be “tested” in the traditional sense, but the
involvement of so many medical professionals alleviates concerns about
differential diagnosis or impermissible rates of error. Similarly, the type of
syndrome presented in Wilkerson and similar cases enjoys professional
standards among the medical community, significant research and publication,
and general acceptance among those in both the medical and legal fields. A
Daubert analysis shows the need to differentiate Kempe’s BCS from its judicial
B. Losing the Significance of BCS
Wholly aside from the effect on courtroom behavior, the current trend in
expanding BCS has disturbing consequences for the nation more generally.
Extending BCS beyond its original intention diminishes the role of Kempe’s
work because it taints the syndrome’s flexibility and extracts it from its basis in
The prevalence of child abuse is certainly a disturbing epidemic; however,
admitting abuse evidence into a courtroom does not serve any general deterrent
purposes. Indeed, “criminal sanctions are a poor means of preventing child
abuse.”184 To the knowledge of the author, no research has indicated that the
judicial use of BCS evidence deters future child abuse. In fact, the introduction
of such evidence only occurs after the abuse has already happened. In the case
of criminal defendants using a self-defense claim, expert witnesses often present
the evidence many years after the maltreatment.185
Of course, Kempe’s BCS does function as a specific deterrent; that is,
convictions are more easily attained. However, if this deterrence is the goal of
the criminal justice system, then a stricter definition of BCS would be even
more helpful. With a concrete set of diagnostic criteria, doctors could easily
label and explain cases of abuse as instances of the syndrome.
From the beginning, BCS was intended to help professionals identify abuse.
“[T]he physician’s training and personality usually makes it quite difficult for
him to assume the role of policeman or district attorney and start questioning
patients as if he were investigating a crime.”186 Yet, as BCS evidence is
expanded in the courtroom, physicians and therapists are asked to do just that.
183. See, e.g., State v. Norlin, 951 P.2d 1131, 1135–36 (Wash. 1998) (citing several cases).
184. Monrad G. Paulsen, The Law and Abused Children, in THE BATTERED CHILD, supra note 8, at
185. See, e.g., State v. Crabtree, 805 P.2d 1, 2 (Kan. 1991) (“The shooting took place some seven
years after the last physical violence to [the defendant].”).
186. Kempe, supra note 11, at 19.
The more that BCS is judicially stretched, the more the syndrome loses its
foundation in medical science. For example, some courts allow battered
children to bring medical malpractice claims against hospitals and physicians for
not diagnosing the syndrome.187 Similarly, criminal defendants may be able to
bring a legal malpractice claim against their lawyers for failing to present BCS
evidence.188 Instead of focusing on the battered child or even the battering adult,
the focus is placed on the lawyer or physician diagnosing BCS. Lawyers have
indeed turned the tables on Kempe.
Furthermore, the problem with always using BCS in criminal cases is that it
loses its essential function as a help to medical and mental health professionals
who are trying to identify abuse. Kempe himself recognized that an emphasis on
the criminal aspect of BCS “impedes the therapy that both pediatricians and
psychiatrists are attempting to give to the parents.”189 Kempe did not find “any
evidence to indicate that failure to criminally punish parents who injure their
children will increase the problem.”190 According to this doctor, the father of
BCS, “[t]he child can usually be protected without the necessity of arresting the
parents.”191 Physicians, not the courts, “are the first line of defense in the fight to
decrease the incidence of the maltreatment syndrome in children.”192
C. The Proper Solution
For those reasons, courts must be careful to distinguish battered child
syndrome from child batterer syndrome. Medical evidence regarding previous
injuries in a child abuse case may be relevant, helpful to the jury, and proper
testimony for an expert witness. However, any evidence regarding who
committed the abuse should be excluded. Such evidence is closer to profile
evidence that masks the real issue in both infanticide and parricide cases.
For example, judges should limit testimony from those who conduct
examinations to the area in which they are admitted as experts. Determining
the cause of death is “the principal purpose for conducting exhaustive
investigation and postmortem examination in harmony with the law
enforcement agency.”193 Although identifying BCS is helpful in determining the
willfulness of a child’s death and eliminating alternate explanations, it is not by
itself a cause of death. Thus, a lawyer’s use of testimony from a pathologist
should be limited to the actual cause of death—the fatal injury—and not the
profile of one who would cause such an injury.
When BCS evidence is admissible, judges should use a special jury
instruction. As Justice O’Connor explained in Estelle, “The fact that a . . . child
was repeatedly beaten in the course of her short life is so horrifying that a trial
court should take special care to inform the jury as to the significance of that
evidence.”194 Judges need to be careful not to “encourage the jury to assume
that [the defendant] had inflicted the prior injuries and then direct the jury to
conclude that the prior abuser was the murderer.”195
Perhaps the best example of proper jury instructions to date concerning
BCS was presented in the case of State v. Moorman.196 The lawyer limited the
expert’s testimony to facts regarding the child’s injuries and did not allow him
to discuss the identity or possible identity of the person who inflicted those
injuries.197 With that background, the judge instructed the jury that it could only
use the expert testimony of prior injuries as evidence that the child’s death was
not caused by a fall down stairs, and not as evidence of any predisposition by
the defendant to commit the crime. The judge advised the jury that it was not
bound to accept the doctor’s testimony as credible evidence as to whether or
not the child’s death was accidental. The judge cautioned the jury that even if it
concluded that the child was a victim of BCS, and had died because of repeated
physical abuse, it could not return a guilty verdict unless it was convinced
beyond a reasonable doubt that the defendant had inflicted the injuries.198
By limiting BCS evidence to Kempe’s original definition and placing the
focus correctly on the battered child, judges will preserve the proper role of the
syndrome—in both medicine and law.
In the medical field, battered child syndrome has left several questions
unanswered. Does the syndrome include mere neglect? Is emotional abuse
sufficient to diagnose BCS? How many injuries are required for a child to be
“battered”? How does BCS relate to other mental diseases and defects? For
physicians, the distinction between one injury and two might not make much of
a difference. For a criminal defendant, that distinction may mean the difference
between prison and freedom.
Thus, evidence of BCS needs to be judicially restricted in a different way
from how it is restricted in the medical context. To the extent that BCS
evidence is about the perpetrator rather than the victim, it is improper.
Regardless of the truthfulness of the evidence, the American criminal justice
system is one of limited information. As the Supreme Court explained:
194. Estelle v. McGuire, 502 U.S. 62, 76 (1991) (O’Connor, J., concurring in part and dissenting in
196. Reported on appeal at 670 A.2d 81 (N.J. Super. Ct. App. Div. 1996).
197. Id. at 85.
We recognize that, in practice, a gatekeeping role for the judge, no matter how
flexible, inevitably on occasion will prevent the jury from learning of authentic insights
and innovations. That, nevertheless, is the balance that is struck by Rules of Evidence
designed not for the exhaustive search for cosmic understanding but for the
particularized resolution of legal disputes.199
Still, “the refusal to face evil serves to perpetuate it.”200 Society should
certainly not ignore the prevalence of child abuse. Hopefully, continued
scientific research into BCS will create a more expansive and more
comprehensive explanation of the syndrome. But, whatever happens in the
medical field, “[i]n order to be fair and consistent, the courts need to come to a
conclusion on how they are going to treat and punish battered children.”201
5. See infra Part II .A.
6. See infra Part II .A.
7. Kristi Baldwin , Note, Battered Child Syndrome as a Sword and a Shield, 29 AM . J. CRIM . L. 59 , 81 ( 2001 ).
8. See generally Samuel X. Radbill , A History of Child Abuse and Infanticide, in THE BATTERED CHILD 3 ( Ray E. Helfer & C. Henry Kempe eds., 2d ed. 1974 ).
9. Bakan, supra note 1, at 166.
10. Id . at 174.
11. C. Henry Kempe et al., The Battered-Child Syndrome, 181 J. AM. MED. ASS'N 17 , 17 ( 1962 ).
12. Id .
13. Id .
14. Id . at 18.
15. Id .
28. Jenny , supra note 25, at 2797.
29. See Inger J. Sagatun , Expert Witnesses in Child Abuse Cases, 9 BEHAV . SCI. & L. 201 , 206 ( 1991 ) (noting that children with BCS usually show signs of repeated abuse).
30. H. Klotzbach et al., Post-Mortem Diagnosis and Age Estimation of Infants' Fractures , 117 INT'L J. LEGAL MED . 82 , 83 ( 2003 ).
31. See generally Doriane Lambelet Coleman et al., Where and How to Draw the Line Between Reasonable Corporal Punishment and Abuse, 73 LAW & CONTEMP . PROBS. 107 (Spring 2010 ) (providing a detailed exposition of the psychological ramifications of corporal punishment in general).
32. Robert F. Anda et al., The Enduring Effects of Abuse and Related Adverse Experiences in Childhood, 256 EUR. ARCHIVES PSYCHIATRY & CLINICAL NEUROSCIENCE 174 , 175 ( 2006 ).
33. Cathy L. Pederson et al., Childhood Abuse Related to Nicotine, Illicit and Prescription Drug Use by Women: Pilot Study, 103 PSYCHOL . REP. 459 , 459 - 60 ( 2008 ).
34. Audrey R. Tyrka et al., Childhood Maltreatment and Adult Personality Disorder Symptoms: Influence of Maltreatment Type, 165 PSYCHIATRY RES . 281 , 283 - 85 ( 2009 ).
35. Christina S. Meade et al., Long-Term Correlates of Childhood Abuse Among Adults with Severe Mental Illness: Adult Victimization , Substance Abuse, and HIV Sexual Risk Behavior, 13 AIDS & BEHAV . 207 , 208 ( 2009 ).
36. Mehmet Sunay Yavuz et al., A Battered Child Case with Duodenal Perforation, 15 J. FORENSIC & LEGAL MED . 259 , 259 - 60 ( 2008 ) (emphasis added).
37. Sagatun , supra note 29, at 206.
38. DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1808 (30th ed. 2003 ).
39. Bakan , supra note 1, at 152.
40. Jenny , supra note 25, at 2797.
41. Yavuz et al., supra note 36 , at 260-61.
42. See , e.g., Deuteronomy 12 : 31 , 18 : 10 .
43. Mary Renck Jalongo , The Story of Mary Ellen Wilson: Tracing the Origins of Child Protection in America, 34 EARLY CHILDHOOD EDUC . J. 1 , 1 - 2 ( 2006 ).
44. Mary Ellen Wilson, Mrs. Connolly, the Guardian, Found Guilty, and Sentenced to One Year's Imprisonment at Hard Labor , N.Y. TIMES , Apr. 28 , 1874 , at 8.
45. Jalongo , supra note 43, at 1.
46. Greeneville Cnty . Dep't of Soc. Servs. v. Bowes , 437 S.E.2d 107 , 112 (S.C. 1993 ) (Toal , J., dissenting).
47. Id . at 112-13.
48. Monrad Paulsen et al., Child Abuse Reporting Laws: Some Legislative History , 34 GEO. WASH. L. REV. 482 , 482 ( 1966 ).
49. Kempe et al., supra note 11 , at 23.
91. McGuire v. Estelle , 902 F.2d 749 , 752 ( 9th Cir . 1990 ).
92. Id . at 754.
93. McGuire v. Estelle , 919 F.2d 578 , 578 - 79 ( 9th Cir . 1990 ).
94. Id . at 584.
95. McGuire , 902 F.2d at 754.
96. Id .
97. See , e.g., Rivera v . Illinois , 129 S. Ct . 1446 , 1454 ( 2009 ) (citing Estelle for due process doctrine); Bradshaw v . Richey , 546 U.S. 74 , 76 ( 2005 ) (citing Estelle for habeas corpus doctrine).
98. See , e.g., Heath v . Roberts, No. 02 - 3349 -JTM, 2004 U.S. Dist. LEXIS 22659, at * 22 - 24 ( D. Kan . Nov. 5 , 2004 ).
99. See , e.g., Thompson v . Henry, No. 1 : 05 -cv-0014-1 ALA HC , 2008 U.S. Dist. LEXIS 76532, at * 49 - 52 (E.D. Cal. Aug. 28 , 2008 ).
100. See , e.g., State v . Heath , 957 P.2d 449 , 463 (Kan. 1998 ) (citing Estelle and approving of doctor who testified about BCS and also testified about the typical caretaker); State v . Koon , 730 So. 2d 503 ,
123. Baldwin , supra note 7, at 62.
124. Jahnke v. State , 692 P.2d 911 , 914 - 16 (Wyo. 1984 ).
125. Id . at 916.
126. See , e.g., In re Appeal in Maricopa County , 893 P. 2d 60 ( Ariz . Ct. App. 1994 ) (raising a selfdefense BCS claim); Johnson v . State , 718 So. 2d 848 (Fla . Dist. Ct. App. 1998 ) (same); People v . Shanahan , 753 N.E. 2d 1028 (Ill . App. Ct. 2001 ) (same); State v . Crabtree , 805 P. 2d 1 ( Kan . 1991 ).
127. Ann W. O'Neill , Defense Rests in Menendez Brothers' Retrial, L.A. TIMES , Feb. 1 , 1996 , at A1.
128. Id .
129. Transcript of Record at 45959, State v. Menendez, No. BA068880 (Cal. Super. Ct. Jan . 11 , 1996 ).
130. Id . at 45956.
131. Id . at 45955.
139. United States v. Hollow Horn Bear, No. 94 - 2484SD , 1994 WL 578218, at * 1 ( 8th Cir. Oct. 20 , 1994 ).
140. See , e.g., In re Appeal in Maricopa County , 893 P. 2d 60 ( Ariz . Ct. App. 1994 ) (approving of the evidence but also affirming the conviction); People v . Shanahan , 753 N.E. 2d 1028 (Ill . App. Ct. 2001 ) (reversing a conviction for failing to hold a Frye hearing on the BCS defense) .
141. Hart & Helms, supra note 2, at 681.
142. Baldwin , supra note 7, at 77-78.
143. Hope Toffel , Note, Crazy Women, Unharmed Men, and Evil Children: Confronting the Myths About Battered People Who Kill Their Abusers, and the Argument for Extending Battering Syndrome Self-Defenses to All Victims of Domestic Violence, 70 S. CAL. L. REV . 337 , 344 ( 1996 ).
144. State v. Nemeth , 694 N.E.2d 1332 , 1334 (Ohio 1998 ).
145. People v. Jackson , 95 Cal. Rptr. 919 , 921 (Cal. Ct. App. 1971 ).
146. State v. Mapp , 264 S.E.2d 348 , 353 (N.C. Ct . App. 1980 ).
147. State v. Crabtree, 805 P.2d 1 , 6 (Kan. 1991 ) ; see also State v . Guyette , 658 A. 2d 1204 (N.H . 1995 ) (holding for a similar rule).
148. See Baldwin, supra note 7 , at 72 ( analyzing the defensive use of such evidence).
149. Sagatun , supra note 29, at 204.
150. Id . at 205.
157. FED . R. EVID. 702 .
158. See , e.g., People v . Leahy , 882 P. 2d 321 ( Cal . 1994 ); Howerton v . Arai Helmet , Ltd., 597 S.E. 2d 674 (N.C . 2004 ).
159. State v. Koon , 730 So. 2d 503 ( La. Ct . App. 1999 ); State v . Nemeth , 694 N.E.2d 1332 ( Ohio 1998 ).
160. State v. Janes , 850 P.2d 495 , 503 (Wash. 1993 ).
161. State v. MacLennan , 702 N.W.2d 219 , 234 (Minn. 2005 ).
162. See , e.g., Erin M . Masson, Annotation, Admissibility of Expert or Opinion Evidence of Battered-Woman Syndrome on Issue of Self-Defense, 58 A.L.R. 5TH 749 ( 1998 ).
163. MacLennan, 702 N.W.2d at 227.
164. Sagatun , supra note 29, at 206.
165. See Howard Dubowitz & Susan Bennett , Physical Abuse and Neglect of Children, 369 LANCET 1891 , 1892 - 95 ( 2007 ).
166. Id . at 1892 .
167. See , e.g., United States v . Boise , 916 F.2d 497 , 503 - 04 ( 9th Cir . 1990 ) (citing several cases concluding that BCS is an accepted diagnosis ).
168. People v. Shanahan , 753 N.E.2d 1028 , 1030 (Ill. App. Ct. 2001 ).
169. Sagatun , supra note 29, at 210.
170. State v. MacLennan , 702 N.W.2d 219 , 233 (Minn. 2005 ).
171. Bakan , supra note 1, at 159.
172. Hart & Helms, supra note 2, at 679.
173. Bakan , supra note 1, at 154.
174. Jeffrey A. Walsh & Jessie L. Krienert , Child-Parent Violence : An Empirical Analysis of Offender, Victim, and Event Characteristics in a National Sample of Reported Incidents, 22 J. FAM . VIOLENCE 563 , 563 ( 2007 ).
175. Jenny , supra note 25, at 2797.
176. Sagatun , supra note 29, at 204.
177. Walsh & Krienert, supra note 174, at 566.
178. See Mike Fitzpatrick , Child Abuse, 363 LANCET 830, 830 ( 2004 ).
179. State v. MacLennan , 702 N.W.2d 219 , 227 (Minn. 2005 ).
180. FED . R. EVID. 702 .
181. MacLennan, 702 N.W.2d at 233.
182. Id . at 230-31.
187. See , e.g., Landeros v . Flood , 551 P. 2d 389 ( Cal . 1976 ); Becker v . Mayo Found., 737 N.W.2d 200 (Minn . 2007 ); Heidt v . Rome Mem'l Hosp., 278 A.D. 2d 786 (N.Y. App . Div. 2000 ).
188. See , e.g., Wade v . Calderon , 29 F.3d 1312 , 1316 - 18 ( 9th Cir . 1994 ) (discussing an ineffective assistance claim).
189. THE BATTERED CHILD, supra note 8 , at 187.
190. Id .
191. Id .
192. Fontana , supra note 22, at 1393.
193. James Tuthill Weston , The Pathology of Child Abuse, in THE BATTERED CHILD , supra note 8 , at 61, 66 .