Quality of Life in Animals
Franklin D. McMillan, DVM, DACVIM (SAIM)
Los Angeles, California
THE ROLE OF FEELINGS
Imagine this scenario: you are asked to evaluate the QOL of a particular dog. You are given two sheets of paper, one white and one yellow. On the white sheet you are to make a list of 20 things in the dog's life that affect his QOL, the yellow sheet is to contain a list of 20 things in the dog's life that have no effect on his QOL. This is easy, you tell yourself. You begin to list things on the white sheet: his arthritis, his flea allergy, the amount of playtime he gets, the aggressive dog in the next yard that menaces and frightens him, interaction from his loving and doting owners, and his delicious food. On the yellow sheet you list the notch in the pinna of his left ear, the absence of one of his toes that had to be surgically amputated several years ago, the three lipomas on his ventral chest and abdomen, his congenitally bent tail, the new kitchen table in his house, and the fancy jewel-studded collar he wears. After you are finished with your lists, you are then asked to explain why each item went on one list rather than the other. There is some quality that the items on the white sheet have that those on the yellow sheet do not, or vice versa. Whether you realize it or not, whatever that quality was that separates the items between the two lists is-you were using it. What was that quality?
Feeling states appear to have evolved to serve as a way to encode relative importance of stimuli bombarding the nervous system. In general, stimuli that are beneficial to well-being elicit pleasurable feeling states, while those that are threatening to well-being elicit unpleasant feelings. In this view, feelings evolved to represent those things that matter to the animal, with respect to the animal's reproductive fitness (survival and reproduction). The intensity of the feeling appears to represent how much those things matter to the animal. Because QOL would presumably involve only those things that matter to the animal, and because feelings represent those things that matter, then it would make sense that QOL in animals is represented by the pleasant and unpleasant feelings in the individual's life over time.
Feeling states play such a central role in QOL that it appears that it is through feelings that anything influences QOL. Anything that does not elicit a feeling of some kind is not important in that individual's QOL. This is again consistent with the notion that feelings represent those things that matter. Examples of factors that elicit feelings include glaucoma or osteoarthritis causing pain, vestibular disease or azotemia causing nausea, deprivation of social companionship causing loneliness, and tasty foods causing pleasant feelings. All of these factors elicit some type of feeling, which would influence QOL. Conversely, painted toenails, Neuticals®, and fancy collars do not elicit feelings, and hence have no effect on the animal's QOL. Likewise for certain medical disorders, such as a small lipoma, an early heart murmur, a small inguinal hernia, or partial vision loss in one eye. If something does not elicit a feeling-pleasant or unpleasant-then it does not affect QOL.
Unpleasant feelings have physical origins-such as hypoxia, thirst, hunger, disease, nausea, full urinary bladder, itchiness, temperature extremes, and pain-or emotional origins-such as fear, anxiety, loneliness, grief, frustration, and boredom. Pleasant feelings also have physical and emotional origins, and include social companionship, mental stimulation, tasty foods, and sexual activity.
In going back to the two lists you were asked to make, we can now see quite clearly what that quality was that differentiated the items on the two lists. All of the items on the white sheet elicit a feeling of some kind in the dog, whereas those items on the yellow sheet do not. In other words, the white-sheet items matter to the animal, and the yellow-sheet items do not.
QUALITY OF LIFE - THE SCALES MODEL
Quality of life in animals appears to be comprised of the balance between pleasant and unpleasant feeling states. In this view, QOL may be viewed as a scales, with pleasant feelings on one side and unpleasant on the other. The direction of tipping of the scales represents the individual's QOL. Quality of life increases when the balance tips toward the pleasant feelings, and declines when the balance tips toward unpleasant feelings.
This model of QOL explains the reason for the intuitive feeling that an animal's QOL is compromised when a painful condition exists (the unpleasant feeling of pain tips the scales negatively), when a pet is abused (the unpleasant feelings of fear, pain, loneliness, hunger, etc, strongly tip the scales), and when a pet is paralyzed (the inability to experience normally enjoyable activities lessens the pleasant feelings in life, thereby tipping the scales toward the unpleasant feelings). In short, unpleasant feelings diminish QOL, while pleasant feelings enhance QOL.
A key feature of the scales model of QOL is that it clearly identifies which factors in the animal's life contribute to its QOL. Anything that tips the QOL scales-in either direction-plays a role in the animal's QOL, but those things that do not tip the scales do not affect the animal's QOL. On the QOL scales the intensity of the feelings dictates the degree to which the scales are tipped, and hence defines the magnitude of influence that factor has on QOL.
DIFFERENTIAL WEIGHTS OF FEELINGS
Feelings do not all carry the same weight in their contribution to QOL; some have greater influence than others.
Unpleasant feelings appear to have evolved as protective mechanisms against threats to the individual's well-being and safety. They do this by forcing the individual to tend to the threat at hand and not ignore it. This is accomplished by inflicting feelings that hurt. Because of this, unpleasant feelings appear to weigh more (have proportionately greater influence) on QOL than pleasant feelings. Among the unpleasant feelings themselves, the intensity of the unpleasantness of the feeling-which focuses the individual's attention on it-corresponds to the degree of the threat to life and well-being. Situations and stimuli which are most urgently threatening to life have come to be associated with the most intensely unpleasant feelings (sufferings) and include such threats as impaired oxygen intake, tissue damage, and impending danger. The feelings these threats generate are, respectively, hypercapnea and panic, physical pain, and fear.
The evolutionary survival value of unpleasant feelings and the differences in urgency of survival threats have resulted in some unpleasant feelings having greater distress potential than others. Our intuition here is correct-pain does carry more weight than many other feelings in QOL-but our intuition does not go far enough. Other unpleasant feelings carry as much weight, and in some cases even more weight, than pain. This is a critically important factor in determining the QOL of the ill animal.
MAJOR CONTRIBUTING FACTORS TO QUALITY OF LIFE
Several factors contribute to QOL, all having their influence through their associated pleasant and unpleasant feelings. Those with the greatest influence include:
Assessing QOL is very difficult, in humans as well as animals. There is no QOL thermometer, no ability to quantify either QOL as a whole or any of the proposed contributing factors. Measuring even a single component of QOL, such as pain, is very difficult; therefore, assessing the much more complex totality of QOL has been exceptionally difficult. At present, this makes QOL measurement a very inexact science.
Measurement of QOL has engendered great controversy and debate in the human field, and there is no consensus as to the best method for assessing QOL. The usual method of collecting QOL information in people is through patient self-assessment questionnaires. This method is not available for QOL assessment in animals.
Measurement of QOL requires quantification of a subjective phenomenon. Because of the inherent difficulties of such a task, many studies of human QOL have been designed to evaluate objective indicators as a means to reflect the subjective status of patients. Examples of objective criteria include activity level, physical functioning, disease and physiologic indices, appetite, and social support and interactions. Subjective criteria involve the way an individual feels about the various aspects of his life (eg, health, companionship) and life overall.
For individuals who cannot offer meaningful first-hand insight into their own subjective mental states, such as human neonates and infants, the mentally disabled, and animals, objective criteria are often relied on as representative of the subjective states contributing to and comprising QOL. Since there is inadequate direct access to these individuals' subjective status, QOL information must come from closely associated alternative sources, such as parents, spouses, partners, caregivers, siblings, and health care providers. Such individuals are termed "proxy" informants. In animals, the owner or other person with the greatest knowledge of that individual animal is the most appropriate proxy. Because all animal QOL assessment depends heavily on proxy information, the issue of the accuracy of proxy measurements is therefore crucial. In human QOL studies, discrepancies are well-documented when a parent assessment of their own child's QOL is compared to the child's self-assessment. The same is true when health professionals' assessments of patient QOL are compared with the patients' self-assessment. This raises a bright red flag for potentially extreme inaccuracies when animal QOL is assessed by humans.
If feelings constitute the basis for QOL, then the intensity of feelings is a crucial factor in measuring QOL. This requires us to quantify feelings which, unfortunately, is not currently possible. Assessment criteria presented in the literature to achieve this include behavioral factors (normal and abnormal behavior and preference studies), neurochemical and endocrine factors (eg, catecholamines, glucocorticoids, and others), health status, physical functioning (disability), immune function, morphologic changes, and brain imaging techniques. None of these criteria is entirely satisfactory.
Guidelines for assessing an animal's quality of life
When assessing QOL it is extremely important that all relevant factors be weighed in. Based on the feelings-dependent QOL model presented here, this includes any factor-internal or external-which elicits a feeling in the animal.
The first step in measuring an animal's QOL is to identify all recent and current feelings in the animal's life-pleasant and unpleasant, emotional and physical in origin, health-related and non-health related.
The second step is to attempt to adjust the contributory weight of each feeling for the level of biological importance (ie, survival urgency). Among the unpleasant feelings, proportionately more weight should be assigned to those feelings that are evolutionarily associated with the most urgent and immediate threats to survival, such as hypoxia (actually, hypercapnea), physical pain, and fear. Proportionately less weight should be assigned to feelings of lesser survival threat potential, such as pruritus or frustration (although it must be remembered that any unpleasant feeling, if intense enough, may induce suffering).
Step three is to construct a scales weighing the adjusted-importance feelings. At present, this step is nebulous and in some cases simply a best guess. The key in this step is to make sure that all feelings are included on the QOL scales and that priority (ie, more weight) is assigned to the most life-protecting unpleasant feelings.
The fourth step is to weigh in the individual nature of QOL. Each animal's individual personality and preferences lead to all contributing factors to QOL mattering differently to different animals. For example, something that is a great source of joy to one cat may be meaningless to another cat; likewise, something - like being left alone - that elicits severe emotional distress in one dog may have no effect on another. These individual needs, desires, values, and preferences are critical when evaluating and attempting to maximize QOL. It is preferable to have proxy QOL assessments performed by those persons who have the greatest knowledge of that individual animal's preferences, personality, and nature. This individuality is then used to make the final adjustments to the weights of the feelings on the animal's QOL scales. For example, feelings of separation (like loneliness) would be assigned much more weight in a dog that suffers from severe separation anxiety than a dog that is very relaxed when his owner leaves the house.
The QOL scales assessment has additional value in animals with progressive illness or illness that changes (for the good or bad). Periodically during the course of illness QOL can be serially assessed. This permits us to gauge responses to therapy, the speed of progression of the illness, prognosis, and the time when euthanasia would be appropriate.
OVERALL IMPROVEMENT STRATEGIES IN ILL ANIMALS
The guiding principle for maximizing QOL
Despite the difficulties in measuring QOL, it is fortunate that this problem does not greatly hamper our ability to maximize QOL, as the principle applied is effective at all levels of QOL. Maximizing QOL can be summarized by a single principle: Tip the QOL scales as far toward the pleasant side and for as long as possible. Based on the balance model of QOL, this may be achieved by minimizing unpleasant feelings, promoting pleasant feelings, or a combination of the two.
Maximizing quality of life in the ill animal
In the ill animal the QOL balance is tipped toward the unpleasant side because of the increase in unpleasant feelings associated with the disease state and the impaired opportunities to experience pleasure due to the disabilities associated with the medical disorder. Because of the powerful effects of the unpleasant feelings, the emphasis of maximizing QOL in the presence of disease is the alleviation of the discomforts associated with the disease. Full restoration of health is the ideal means to restore the diminished QOL, but when cure is not attainable then using all treatments available to alleviate unpleasant feelings of the disease is the key means to increase QOL. This includes medications, surgery, and all other interventions that make the animal feel better.
Mental illnesses and disorders play as important a role in the animal's QOL as physical illnesses. Emotional illnesses, such as phobias and separation anxiety, elicit unpleasant feelings that are equally or more distressing than the feelings of physical illnesses. The intense fear experienced in phobic disorders, especially when the condition is unrelenting, may cause the animal to suffer intensely. Alleviating discomforts of mental illnesses is as-or more-important as alleviating those of physical illnesses for QOL.
In addition to alleviating the unpleasant feelings associated with the disease, tipping the QOL scales toward the pleasant side also involves the promotion of pleasant feelings. In human patients with terminal disorders, for example, QOL is often substantially elevated through increased social support, fun activities, and humor during the course of illness. Providing the ill animal with more pleasurable experiences will enhance QOL. Sources of pleasurable feelings include social interaction and companionship (with humans and other animals), mentally stimulating and engaging activities (variety, challenges, play, chase-and-pounce games, fetch games, hunting for hidden objects and food treats, outings, interactive toys, leash walks outside, a continuous supply of novel objects to investigate and explore such as cardboard boxes, tree branches, objects), taste pleasures (palatable foods, snacks), human contact (petting, massage, laying in lap), climbing, digging up things, lounging in sunlight, and enjoyable sights, sounds, and smells. Because of the individual nature of QOL, the type and quantity of pleasure-eliciting stimuli must be individualized for each animal. The person who is most familiar with the animal's unique personality and nature is best suited to compile the list of pleasures to be used in the QOL maximization program.
For patients with disabilities, such as paralysis disorders or blindness, QOL is diminished because of the lost or impaired abilities limiting the opportunities to experience pleasures, such as chasing, running, and playing. These losses can be at least partially restored through such measures as carts and sling-walks for paraparalysis patients and hand signs for communication with deaf animals.
It is important to be sure that pleasant activities are suitable for the specific disease or disability. Chasing a ball, for example, may be inappropriate for a patient with CHF. Any pleasurable feelings that can be increased without risking additional unpleasant feelings should be fully promoted. Even activities which elicit unpleasant feelings may be beneficial to QOL, as long as the net effect is to tip the QOL scales toward the pleasant side. For example, if going on walks leads a dog to feel some discomfort of arthritis, but the walks are highly pleasurable and desired, then continuing the walks would be expected to result in a net improvement to QOL.
As disease states progress, the QOL scales will tip increasingly toward unpleasant feelings. This will be due to increasing magnitude of the unpleasant feelings and decreasing pleasurable feelings. Eventually, efforts to increase QOL will be insufficient to counteract the heavily negative tipping of the scales. At the point when the unpleasant feelings substantially outweigh the pleasant feelings, QOL is sufficiently poor to justify euthanasia.
The preventive aspect of maximizing quality of life
Enhancing QOL associated with disease does not always involve a current illness. Many QOL-maximizing actions are taken to assure the highest QOL in the future. One example is immunizations, which are intended to protect the animal from any future harm of certain infectious diseases. Frequently, a medical disorder exists that has not yet caused clinical illness. An example is a severe thrombocytopenia detected in an asymptomatic animal on a routine preanesthesia blood screen. The asymptomatic condition may have no current impact on QOL because no feelings have been elicited, the animal is unaware of the condition, and hence QOL is unaffected. However, the fact that QOL is currently not influenced does not mean that no QOL enhancement actions are indicated. Measures are taken now to lessen the risk of a future impairment to QOL, thus effecting an enhanced future QOL.
Nothing is more important in veterinary medical care than the maximization of QOL. From the animal's perspective, the way its disease is treated, or even if it is treated, is unimportant as long as you, the practitioner, can increase the animal's QOL. Maximizing QOL is accomplished by the dual effort of minimizing unpleasant feelings and promoting pleasurable feelings. This keeps the QOL scales tipped as far toward the pleasant side for as long as possible, giving the animal the greatest possible experienced pleasantness in life.
Stress and its Affects on Health in Veterinary Patients
Introduction - What is Stress?
Stress is currently a widely and very loosely used term for describing complex and incompletely understood responses to novel, challenging, and threatening stimuli. Unfortunately, stress has now come to serve as an over-simplified catch-all term used to refer to virtually any aversive physical or psychological condition.
Animals are said to experience "emotional stress," "psychological stress," "psychosocial stress," and "mental stress," "crowding stress," "hospitalization stress," "isolation stress," "noise stress," and so on. Animals are frequently said to "encounter stress," "experience stress," "be stressed," "be under stress," "endure stress," "suffer stress," "exhibit signs of stress," "go through stress," "have times of stress," "resist stress," "avoid stress," and "cope with stress."
What is stress? Surprisingly, no one seems to know for sure. Or to be able to define it precisely. Most researchers feel that the defining feature of stress is the restoration or preservation of threatened homeostasis, which may be defined as a state of psychological and physiologic equilibrium or balance in which certain vital signs such as body temperature, acidity, blood glucose level, and so on, are all maintained in an optimal range for survival. Deviations from homeostasis represent a threat to reproductive fitness; hence, animals have evolved effective mechanisms for detecting and correcting such deviations. The stress response appears to be a major part of this process.
Emotion versus Stress
Stress and emotion are deeply intertwined concepts and coexist in many situations in which stress mechanisms are activated. In the scientific literature stress and emotion are routinely blended and frequently equated-"stress" and "unpleasant emotion" (e.g., fear, anxiety, etc.) are often treated as one and the same and are regularly used interchangeably.
If we look at two main goals in animal care: (1) minimize unpleasant emotions, and (2) minimize stress-we must ask: Are the two goals, and the methods of achieving them, the same? If not, how do they differ? Do aversive events, such as separation from a bonded social companion, elicit stress, emotion, or both? Or do aversive events elicit an emotion, which elicits stress, or stress, which elicits emotion? When a dog with severe separation anxiety is left at home and destroys furniture and frantically claws the door to escape, is the dog experiencing stress, anxiety, fear, or something altogether different? These are important questions that need to be answered for us to effectively relieve an animal's "stress."
Emotional responses, like physical responses, function to preserve, protect, or otherwise maintain homeostasis. Examples of emotions that accompany stress responses are fear when approaching a cliff edge, loneliness (or other feelings of isolation and separation) when social animals are separated from companions, and frustration when unable to achieve a desired goal. When an emotion is elicited there is often activation of the major stress mechanisms: the sympathetic and hypothalamic-pituitary-adrenal systems. When a threat is significant, the stress response will activate the fight-or-flight response, which is crucial to survival.
But although emotion and stress frequently co-exist, "stress" does not equal "unpleasant emotion." When the primary homeostasis-preserving mechanism is an emotion, stress is not the emotion. Fear (or any other negative emotion) is not stress, and stress is not fear. However, the stress response appears to serve as part of the emotional response, bringing arousal, mental focus, and additional energy resources. This is critical for our stress relief efforts-we want to treat the negative emotion, not "stress" per se.
What Causes Stress to/in/on/for Our Animal Patients?
Stress responses are triggered by a wide array of physical and emotional factors. Research has shown that of the two, emotional factors are the more potent stimuli for stress response activation.
A rapidly expanding body of clinical and experimental evidence in animals supports a strong influence of emotional states on the course and outcome of physical illnesses in animals.
In preserving body homeostasis and integrity, all defense mechanisms-behavioral, immunologic, detoxification, wound healing-work cooperatively as a unit; to accomplish this, there must be a constant exchange of information throughout the body cells and systems to coordinate integrated and organized responses. Neuropeptides, hormone-like messenger molecules, and their receptors form a network of information exchange which extends throughout the brain and body, creating a complex functional link between the endocrine, immune, and nervous systems-all of which are in constant communication with each other and integrated with the processes regulating behavior, mood, and emotions. The "stress hormones," especially the adrenal glucocorticoids, link multiple body systems; this well-known interaction is frequently seen as a stress-induced immunosuppressive response. This constant flow of intersystemic communication appears to be the best explanation for the mind-body connection.
Psychoneuroimmunology is a relatively new field of medicine which studies the interactions among the psychological state (psycho-), neuroendocrine system (-neuro-), and immune system (-immunology). Psychoneuroimmunology provides a framework for examining the relationships between behavioral and biological phenomena and their influence on health outcomes.
The protective function of the stress response-energy mobilization, suppression of noncritical bodily functions, mental arousal, and vigilance-is adaptive in the short run but not suited for and destructive in the long run. In an animal's natural environment, threats rarely persist for more than a few minutes. When the stress response remains activated for prolonged periods-in situations rarely occurring in the natural environment, such as confinement, deficient stimulation, and chronic or extreme overcrowding-the harm becomes manifest in the form of somatic and mental pathology. This makes the effectiveness of turning off of the stress response as critical to well-being as its turning on; failure of the stress response to shut off properly is the basis for harm. Virtually no aspect of the animal organism escapes this harm, including disorders of the immunologic, hemolymphatic, gastrointestinal, cardiovascular, musculoskeletal, nervous, urinary, and reproductive systems.
Anxiety and fear - Impaired immunocompetence to cancer and infectious agents, faster development of atherosclerosis, onset of clinical signs of idiopathic lower urinary tract disease in cats, increases in blood pressure, gastrointestinal diseases, increased toxicity of certain medications, and death (literally "scared to death").
Social emotions - Emotions associated with social relationships cause a wide variety of pathologic effects if social bonds are disrupted, severed, or impaired. Disruption of the mother-infant bond causes immunosuppression in the infant. Immune disorders also occur in monkeys when members of their social groups are frequently changed. Social affiliation can lessen the adverse immunologic consequences of social stressors in nonhuman primates. Separation anxiety in dogs can cause intestinal disorders such as diarrhea and bloody stools.
Boredom - In farm animal species, understimulation from a socially deprived environment resulted in higher mortality and physiologic changes, such as a high incidence of atherosclerosis. Conversely, enriching the environment results in improved reproduction and endurance against disease. Increasing the complexity and stimulation of the environment has a favorable effect on health and results in low susceptibility to disease in nonhuman primates.
Anger - In dogs, anger was associated with cardiac disorders, such as coronary artery disease and myocardial ischemia.
In all, current research suggests that all body systems in animals communicate with and influence one another, mental states exert a profound effect on the course and outcome of health and disease states, despite some contradictions in the experimental data the adverse effects of emotional stress are a scientific reality, the negative health effects of "stress" are due to failure of the stress response to shut off, and all known pathologic processes in animals are, to some extent, subject to the influence of emotional states.
A number of factors have been found to dramatically lessen the adverse impact of stress on the animal.
Given the vital role of the stress response in animal defense systems, the ideal goal of stress management is not to eliminate stress, but to lessen the intensity or mental impact of the unpleasant experience and protect against pathologic effects while preserving the ability of the stress mechanisms to respond to perceived threats.
Two Step Program for Stress Management in Animals
Emotional Neglect and Abuse in Animals
Animal neglect and abuse (collectively, maltreatment) has received much attention in the popular press, periodically reignited by publicized incidents of deliberate cruelty that provoke widespread public outrage. Unfortunately, the efforts at combating animal neglect and abuse have encountered the same problem seen in the field of child abuse and neglect: a disproportionate focus on physical neglect and abuse, with little attention devoted to the emotional forms of maltreatment. Childhood emotional abuse does not generate the public-or professional-concern that physical and sexual abuse do, largely because by not leaving visible scars or overt injury as for physical neglect and abuse, it is harder to recognize. In animals, the discrepancy in reaction and response (legal and otherwise) to emotional, as opposed to physical, maltreatment closely resembles the early situation in the field of child abuse. The focus of abuse and neglect in animals has traditionally been on physical harm, also likely due primarily to the fact that the outcome of physical trauma is graphic and shocking in nature as compared to that of emotional trauma. Current efforts to detail the signs of animal maltreatment have overwhelmingly addressed signs of physical abuse and neglect; no such standards have been proposed for emotional maltreatment.
This deficiency in animal care and protection is especially important in light of the recent advancements in the study of the psychological components of animal well-being. In the past three decades, there has been a rapid proliferation of research in the fields of the cognitive sciences, ethology, comparative psychology, neuroscience, and clinical animal behavior, which collectively has led to a vastly increased understanding of emotions. This new knowledge has alerted scientists and nonscientists alike to the scope of animal suffering that is associated with mental states and expanded the scope of animal care to include the attendance to emotional needs, distress, and suffering. Because of the potential for emotions to inflict discomfort, anguish, and suffering, the goal of understanding and addressing emotional maltreatment in animals necessarily deserves a high priority.
The emotions with the greatest relevance to emotional maltreatment are the negative, or unpleasant, emotions. In this category substantial evidence exists in animals for the experience of fear (and phobias), anxiety, separation anxiety (or separation distress), loneliness (and isolation-related emotions), boredom, frustration, anger, grief, helplessness, hopelessness, and depression.
Problems in Definition
A consensus on definitions and terminology in the study of emotional abuse and neglect in children continues to elude researchers. Whereas all forms of childhood neglect and abuse have proved difficult to define, the very private, subjective, and nebulous qualities of emotional maltreatment present especially difficult definitional challenges. The problems faced in the human field become even more difficult in our dealings with animals. As has been noted in regard to parenting methods with human infants, what some may consider in animal care to be abusive, others may consider acceptable, necessary, and even normal care. Child abuse had existed for millennia, but it wasn't until 1962 that the landmark paper "The Battered Child Syndrome" by Kempe et al. formally established the clinical criteria for physical abuse-the "battered child."
To date, no comprehensive and reliable description of the "battered pet" exists that is in any way comparable to the clinical picture in children. The little that has been written focuses almost exclusively on physical neglect rather than abuse. For example, a scoring tool has recently been developed at Tufts University for evaluating body condition through an objective quantification of physical neglect.
Actual or potential harm is one key component in defining maltreatment. The intent of the caregiver also plays a role in maltreatment. However, this role is not at all straightforward for regardless of the differences in caregivers' intentions-be they beneficent, disciplinary, or malicious-the victim's perspective is that any harm, injury, pain, morbidity, or mortality is the same. It is for this reason that the prevailing view holds that intent should not be considered when defining maltreatment in children or animals. Applying this principle to animal care, maltreatment is defined by the animal's harm or risk of harm, independent of the caregiver's intent. Intent is important, however, in categorizing the acts of maltreatment as neglect or abuse.
Quantification presents additional problems in defining maltreatment. At what point, or quantity, does an act that is aversive to the animal become maltreatment? For example, crate training is a currently popular method of raising and training a dog. In units of time, where is the point at which confining a dog to a crate turns from an acceptable action to emotional neglect or abuse? One hour? Twelve hours? Three days? Six months?
Maltreatment, Neglect, and Abuse - Physical and Emotional
Maltreatment may be defined as actions or inactions that are neglectful, abusive, or otherwise threatening to an individual's welfare. It is commonly used as a collective term for its two constituent parts: neglect and abuse.
Neglect is widely considered to be a passive process, or an act of omission, in which the basic needs-physical as well as emotional-of a dependent individual are not adequately met by the caregiver(s). Neglect is distinguished by its lack of intent to harm. In animals, it has been estimated that neglect accounts for 80 percent or more of instances of maltreatment. Needs, which constitute the basis for neglect, can be physical or emotional; hence, there are two types of neglect-physical and emotional.
Abuse, in contrast to neglect, is an active process consisting of acts of aggression with intent to harm the victim. Like neglect, abuse also exists in physical and emotional forms.
The classification schemes for maltreatment in children typically identify four major types: physical abuse, sexual abuse, neglect, and emotional abuse. Because sexual abuse appears much less important in animals-both by frequency and emotional damage-categories for maltreatment in animals is more simplified. Animal maltreatment may be divided into four categories: physical abuse, physical neglect, emotional abuse, and emotional neglect. Examples for each category are included in the accompanying table.
© 2005, Blackwell Publishing, Ames, Iowa, Mental Health and Well-Being in Animals
Let us look now specifically at emotional maltreatment. In children the most widely utilized classification scheme is that developed by Garbarino et al. in their landmark 1986 book The Psychologically Battered Child. Here they identified five forms of psychological (emotional) maltreatment: rejecting, terrorizing, isolating, corrupting, and ignoring. Rejecting involves actions that send messages of rejection to the child; ignoring is being psychologically unavailable to the child; terrorizing refers to behavior that uses intense fear as a weapon against the child (creating a climate of fear or unpredictable threat, hostility, and anxiety, thus preventing the child from gaining feelings of safety and security); isolating involves cutting the child off from normal social relationships; and corrupting is missocializing the child into self-destructive and antisocial patterns of behavior (teaching and encouraging destructive antisocial behavior, reinforcing deviance, and making the child unfit for normal social experiences).
The role of emotional needs - In the course of evolution, needs and feelings appear to have forged a critically important relationship. Evidence suggests that the brains of higher animals are constructed such that the animal is signaled, through unpleasant feelings, when it needs something, whether it be a physical factor such as water, salt, or warmth or an emotional factor such as social companionship. An emotional need may thus be defined as any need that is signaled by an emotional affect (feeling).
When a need is insufficiently satisfied, unpleasant feelings will persist until the need is fulfilled (or the need otherwise abates). When one is motivated to lessen unpleasant affect but is unable or unsuccessful in achieving this goal, distress may result. For example, if a social animal such as a dog were motivated by unpleasant loneliness-like feelings to seek companionship (an emotional need) but was prevented from meeting the need because of solitary confinement in a backyard, then the unpleasant emotional feeling would persistently exert its effects. For this reason, any caregiver actions (or inactions) that impede the meeting of emotional needs would be harmful to animals.
Emotional neglect refers to a failure to meet the emotional needs of the individual (child or animal). Emotional neglect in children causes harm to the child because of inadequate provision for the emotional needs necessary for mental health and well-being.
Emotional needs are the foundation for emotional neglect; therefore, knowledge of the emotional needs of the individual is necessary to recognize and prevent emotional neglect. This is often a challenge in infants and toddlers but is a much more complex problem in animals. Emotional needs in animals vary widely according to such factors as species, sex, age, and individual traits. However, a number of emotional needs have been widely accepted as being shared by most sentient animals, and include
Emotional abuse can be defined similarly in all sentient species (including human) as the deliberate infliction of emotional distress on another individual.
Categories of emotional abuse identified in children that have direct application to animal care include rejecting, terrorizing, taunting, isolating, abandonment, and overpressuring. Rejecting is an active, purposeful denial of a child's or animal's emotional needs for which the resulting emotional deprivation is intended by the abuser. An example in animals would be the dog that is excessively confined to a small crate as punishment for a minor incident of undesired behavior such as whimpering for attention or getting hair all over the couch. Terrorizing refers to the creation of a "climate of fear" or unpredictable threat or hostility, preventing the victim from ever enjoying feelings of safety and security. Included in this category is the use of discipline and punishment that is inconsistent and capricious, extreme, or bizarre. An example of this type of abuse would be the use of harsh punishment in training (breaking) circus elephants to achieve control, domination, intimidation, and rule by fear. Taunting includes any teasing, provoking, or harassing that causes frustration, anger, or mental anguish. Examples include taunting a dog at the end of a tether or from behind another barrier such as a fence or cage bars. Isolating involves the active prevention of social interactions and companionship and is a source of emotional distress for social animals. Abandonment is the desertion and termination of care by the caregiver. This category of abuse overlaps with neglect because of the failure to meet the victim's needs; however, it is an active rather than passive behavior on the part of the caregiver. Examples include discarding a litter of kittens in a garbage dumpster, tossing a pet dog onto the roadside in the country to fend for himself, or moving out of an apartment and leaving a pet animal behind. Overpressuring in humans involves excessive demands and pressure placed on the child to perform or achieve. Examples in animals might include situations in which performance animals-such as race horses, circus animals, sled dogs, and marine mammals used in shows-are driven to perform in excess of their physical or mental capabilities.
Proposed Definition of Emotional Maltreatment
A definition of maltreatment, whether referring to physical or emotional forms, must meet certain criteria. It must specify, to the greatest extent that current knowledge permits, the central role of affect in the harmful effects, the issue of intent, criteria for differentiating lesser actions that do not rise to the level of maltreatment from actions that do, and exemption criteria for those actions that cause emotional harm but are intended to benefit the animal (such as eliciting fear in a cat by taking it to the veterinarian's office for medical care).
The following is a proposed definition of emotional maltreatment: Actions (or inactions) of the animal caregiver or other person(s) which, intentionally or unintentionally, cause, perpetuate, or intensify emotional distress. Emotional distress is here defined as unpleasant emotional affect at a level that exceeds coping capacity. Such actions (or inactions), when intentional, are not maltreatment when a reasonable expectation exists that the ultimate outcome will be a meaningful net increase in that animal's overall (psychological and physical) well-being. Emotional maltreatment consists of two types: passive neglect and active abuse.
Emotional Maltreatment as the Core of All Maltreatment
Because no form of childhood maltreatment is believed to occur without coexisting fear, terror, anxiety, loneliness, hopelessness, helplessness, or other negative emotional state, emotional maltreatment is considered part of all other forms of abuse and neglect, and all maltreated children are regarded to be victims of emotional harm. Emotional maltreatment is regarded as the core issue and major destructive force in the broader topic of child maltreatment. In animals, Ascione and Barnard have stated that an abused animal may also be considered emotionally maltreated.
The Harms of Emotional Maltreatment
Contrary to the gut-level sense that physical abuse and neglect are more harmful than emotional maltreatment, much evidence exists to show that the reverse is true. A growing consensus exists among childcare professionals that emotional maltreatment has the potential to harm the child in ways over and beyond the effects of physical injuries and is more damaging in the long term than other forms of abuse. In animals, some unpleasant emotional states appear to have a greater impact on animal well-being than physical pain.
At present, identifying the harm of emotional maltreatment in an animal is very problematic. The harm of emotional maltreatment is dependent on the coping ability of the individual. When dogs are separated from their owners and confined to cages (such as in a boarding facility), some dogs clearly cope better than others.
The harms of emotional maltreatment in children appear to bear considerable similarities with those in animals; however, extreme caution must be exercised in drawing analogies because much of the harm in children involves complex cognitive processes such as damage to self-esteem. The harms in children that have reasonable applications to animals include impaired ability to learn, inability to build or maintain satisfactory social relationships, inappropriate behavior and feelings under normal circumstances (e.g., separation anxiety), a pervasive mood of unhappiness or depression, and a tendency to develop physical symptoms.
It is well-recognized in children that the consequences of emotional maltreatment can be immediate and long-term. The immediate harm comes from the emotional pain of the unpleasant emotional states elicited by the maltreatment, and include fear, anxiety, isolation and social deprivation, boredom, frustration, anger, helplessness, grief, and depression. Another type of immediate harm involves the adverse effects of unpleasant emotions ("stress") on physical health.
Because of the unknown history of many animals and the lack of studies, knowledge of the long-term consequences of emotional maltreatment in animals is virtually nonexistent. As a result it has become common for clinical behaviorists, veterinarians, and pet owners to assume earlier abuse when an animal shows certain signs such as an unreasonable or excessive fear of humans.
In humans and animals, when emotional maltreatment occurs during the individual's formative stages of life, healthy brain development is impaired, which leads to numerous emotional problems throughout life. Social isolation or abandonment of dogs by their caregivers can intensify some dogs' attachments for their owners and may lead to separation-related emotional distress problems in adulthood. Rescued, shelter-obtained, re-homed, and abandoned dogs have a significantly higher risk for separation anxiety than dogs coming from more stable environments or living in stable homes. Emotional maltreatment in later life may also inflict long-term harm. Psychological trauma in dogs of any age may cause manifestations of severe mental disorders and maladaptive behavior that endure for a lifetime; animals have demonstrated many of the signs of post-traumatic stress syndrome.
Preventing Emotional Maltreatment
Research is needed in identifying the signs of emotional maltreatment, which would, at the minimum, entail study of the behavior of animals with documented histories of emotional neglect and abuse.
Education of the public is a critical step in the prevention of emotional maltreatment. Aware that most of the emotional neglect in children is a result not of malice but of an inadequate understanding of the child's emotional needs, child protection workers have focused on educating the well-meaning parents to make the home more nurturing and emotionally fulfilling for the child. Similar principles would apply to animal care. Researchers as well as animal control officers believe that although some harmful actions are done intentionally, most maltreatment stems from high levels of frustration, a lack of resources, and insufficient knowledge about the animals' needs and about responsible ways to care for animals. If correct, this would mean that the overwhelming majority of animal maltreatment involves neglect rather than an intent to harm.
For public education to be effective, it is first essential that veterinarians, animal control officers, and humane workers be well educated about emotional maltreatment. Counseling on proper animal care is only possible if the animal care professional is knowledgeable in all aspects of care, including emotional needs and sufferings. The training of humane workers and animal shelter personnel would then be used in the screening process for prospective animal adopters. During the screening, questions regarding a potential adopter's ability to meet the animal's emotional needs should carry equal weight as the standard questions about meeting the animal's physical needs of nutrition, water, shelter, and health care.
An effective prevention program must include enactment and strong enforcement of humane laws that recognize and clearly define emotional maltreatment. Current state cruelty statutes need to be amended to include emotional injury, pain, suffering, and trauma. In addition, progress in child protective services demonstrates the benefits of mandated reporting of all forms of maltreatment. With the advent of definitions and mandated reporting statutes for child neglect and abuse there occurred a substantial strengthening of the response to cases of child maltreatment. It is reasonable to believe that taking the same steps in the recognition and reporting of animal maltreatment would similarly strengthen the response to animal maltreatment. Some researchers have suggested the possibility that someday mandated training of veterinary medical students and graduate veterinarians on identification and reporting of animal abuse and cruelty may be required as a prerequisite for licensure, just as the state of New York mandates training on recognizing and reporting child abuse for licensure of physicians, psychologists, psychiatrists, nurses, teachers, and other professionals.
From an ethical and scientific standpoint, the rationale and principles for managing pain are essentially the same for physical and emotional pain. Unpleasant emotions harm the animal by way of the distress and suffering they cause and by the adverse health effects with which they are associated. It is reasonable to believe that the animal experiencing unpleasant feelings does not care about the source of the discomfort-whether it has an emotional or physical origin-but simply that the animal only desires to be rid of the unpleasantness. This applies to all aspects of the animal's life, but particularly to the distress and suffering caused by neglect and abuse.
It is probable that many of the behavioral problems presented to veterinarians, behaviorists, and trainers are caused, at least in part, by emotional maltreatment. It is also possible that many somatic health disorders seen in veterinary medical practice are associated with emotional maltreatment. If this proves to be the case, then emotional maltreatment will assume a heretofore unrecognized prominence in veterinary care.
Animal abuse and undesirable behavior may have an especially detrimental relationship. It has been said that undesirable pet behavior is the most likely cause of animal abuse. Conversely, emotional neglect and abuse can cause abnormal and undesired behaviors such as fear aggression, anxiety-induced inappropriate urination, excessive vocalizing, and self-injurious behaviors. This sets up a highly destructive vicious cycle in which undesired behaviors may lead to rejection, resentment, and loss of affection by the pet owner (i.e., emotional neglect), which then exacerbates the undesired behavior, which then causes more resentment and rejection, and on and on. More tragic is when abnormal behavior cycles with abuse. In these cases, the undesired behavior elicits yelling, social deprivation through banishment to outdoors, or the threat of abuse as punishment for the behavior, which then may perpetuate or worsen the behavior. One example is the cat with anxiety-induced inappropriate urination in a multi-cat household to which the owners respond with yelling and threatening, which creates a heightened climate of fear, causing the cat to urinate even more around the house, which leads to more yelling, and so on. In such cases, the animal may ultimately be relinquished to the local animal shelter or face euthanasia. Only an understanding of the emotional needs of animals and the motivations for the undesired behaviors can avert these heartbreaking situations.
Certainly one of the largest impediments to moving forward in our efforts to tend to emotional maltreatment is the difficulties inherent in recognizing emotional maltreatment when it occurs and discerning the signs of emotional harm; however, the same problem plagued the early efforts in the field of childhood emotional maltreatment. Ludwig (1992) commented that the difficulties in defining maltreatment are not a reason to shrink from the duty to protect children. He further noted that definitions may vary between individuals and change over time, commenting that, "Child abuse as a concept has evolved over time and will continue to evolve. What was considered to be normal child care practice 50 years ago may now seem abusive. The way our children are treated today may be viewed as abusive by future generations" (Ludwig 1992). The same can be said about animal maltreatment. Disciplinary practices viewed as acceptable in the past, such as beating horses and shoving dogs' faces in feces, have changed over time and are now widely considered to be unacceptable.