Intimate Partner Violence: Compassionate Care, Effective Assessment _ _______________________________
“He beats her but she keeps going back!” As noted above, the victim and perpetrator may live in the cycle of violence where, after the abusive event, the perpe- trator feels guilty, apologies, brings flowers, and promises to never repeat the abuse. The victim hopes the perpetra- tor will embody their better sides moving forward. Other factors to consider are that the victim may be emotionally or financially dependent on the relationship, making it difficult to leave. Often victims have a family history of violence and so IPV relationships may be seen as normal. Lastly, women may internalize blame and responsibility. The message that IPV is the victim’s fault gets reinforced by repeated messages from the abuser and/or generalized societal, cultural, and media- transmitted messages that support social norms of submissiveness, inadequacy, or disempowerment. Women are often socialized to avoid conflict and promote harmony within the family at all costs. If they feel, for example, that the abuse prevents abuse of their children, then it may be perceived as not too high a price to pay for a peaceful household. ”Yes, he hit me but it’s my fault. I made him angry.” Viewing an instance of abuse as a result of one’s own actions is more empowering than if the person has no control. So justifying the abuser’s actions is one way to legitimize his actions. Additionally, with the cyclic nature of the IPV relationship, the terrorism and intimidation often build up prior to the event and usually become so intolerable that the abused does something to end the terrorism and initiate the abuse. “She presents with arm pain and odd injuries, but always denies IPV.” Reluctance on the part of a patient to disclose informa- tion about current or past abuse, even when specifically asked, may be due to embarrassment, shame, hope that the relationship can improve, or fear of retaliation by the perpetrator. External factors can also play a role: for example, the social pressure to avoid “losing” a partner or economic dependency. “We just fight. I hit him and he hits me.” Abuse occurs most often in a one-way direction. However, survivors may strike back in self-defense, which can then be used to excuse the behavior of the abuser. “He seems to be such a caring guy – there with her every visit and won’t leave the room.” Caring and controlling can manifest as similar, or even identical, behaviors that can be difficult or impossible to distinguish without long-term observation. “He’s losing his job and now, for the first time in 20 years, he hit me.” Abuse may evolve from non-violent to violent in tandem with stressors experienced by the perpetrator. Pregnancy, which can refocus a woman’s exclusive attention away from her partner, can also serve as a trigger.
OBSTACLES TO LEAVING AN ABUSIVE RELATIONSHIP
Survivors of IPV may face many barriers to leaving an abuser or to taking steps to prevent further abuse. The abuser may threaten to hurt or kill the victim, for example, or take away or hurt the children if the victim attempts to leave. Other potential obstacles include: Economic and logistical constraints Abusers often control the financial resources of the household as well as access to telephones, computers, passwords, car keys, and even medication and food, making it difficult for survivors to leave because they cannot (or believe they are unable to) independently support themselves and their children. They may track their partner electronically or call and text hundreds of times a day. Survivors may not know where to seek shelter or may be afraid to ask. Social isolation The abuser often prevents the victim from communicating with friends and family. Isolation leaves abused individuals psychologically dependent on the abuser as the sole source of social support and the only person who explains or interprets what is happening in the relationship. Feelings of failure Many survivors have been made to feel, by the abuser as well as by others, that they are failures and are responsible for hav- ing brought on the mistreatment. Survivors may also believe that their children need or deserve a two-parent family, even at the expense of their own safety. Social pressures, e.g., “not keeping your man” can also play a role. Promises of change A victim may believe the abuser’s expressions of remorse and subsequent promises that it will never happen again. He or she may feel that the abuser can change. Some survivors also feel it is somehow their responsibility to change or redeem their abusers. While some survivors may want the relationship to continue, most also clearly want the violence to stop. Religion Some victims may expect to endure sacrifices in life, and that suffering in this life will be rewarded in the next life, or that their current situation is due to acts committed in a past life. Others believe deeply in forgiveness and the power and grace it brings them to forgive the transgression of others. Some people view the breaking of marriage vows as sinful, or inter- pret religious texts as reinforcing control and domination. Religiously based support may not embrace personal safety and resources for abused women. Influences by religious leaders may reinforce a subordinate role for wives.
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MDFL0627
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