Domestic abuse in the United States is a large-scale and complex social and health problem. The family is perhaps the most violent group, with the home being the most violent American institution or setting today. Sadly enough, the majority of people who are murdered are not likely killed by a stranger during a hold-up or similar crime but are killed by someone they know. Not surprisingly, the Center for Disease Control and prevention has identified interpersonal violence as a major public health problem (Herman, 1997).
Current estimates suggest that three to four million women are the victims of physical abuse by their intimate partners (Herman, 1997). According to the FBI, some form of domestic violence occurs in half of the homes in the United States at least once a year (Walker, 1984). In reality in one out of every six marriages the wife is physically abused. Every fifteen seconds a women is battered in the United States. Daily, four American women lose their lives to th!
eir husbands or boyfriends, equaling more than one-third of all female homicide victims (National Institute of Justice, 1996). These numbers report that too much violence is directed toward women. Historically, domestic violence has been downplayed and, oftentimes, culturally condoned in America. In the colonial period, laws derived from English common-law permitted a man to beat his wife when she acted in a manner that he believed to be inappropriate.
For example, the so-called “Rule of Thumb” law, which permitted a husband to beat his wife with a stick that could be no larger than the circumference of his thumb, was in effect until the end of the nineteenth century (Walker, 1984). The issue of domestic violence, especially wife abuse, first gained national attention in 1974 with the publishing of Scream Quietly or the Neighbors Will Hear by Erin Pizzey, the founder of Chiswick’s Women’s Aid, a shelter in England for battered women. Pizzey’s work helped to stimulate feminist!
concern and outrage over wife beating, verbal abuse, financial restrictions and social isolation of women by their husbands (National Institute of Justice, 1996). Shortly thereafter, the women’s liberation movement, through the National Organization for Women (NOW), advocated for the end of violence against women and sought improved social services for battered wives. NOW also was actively engaged in promoting shelter homes and lobbying congressional leaders for legislation that would result in better treatment and protection of women’s health and well-being (National Institute of Justice, 1996).
The medical profession was greatly affected by the advocacy of the women’s liberation movement and has, in recent years, attempted to combat this social ill both by itself and in coordination with the legal and social service professions. For example, beginning in 1992, the Joint Commission on the Accreditation of Health Care Organizations, required that all accredited hospitals impl! ement policies and procedures for identifying, treating and referring victims of abuse (National Institute of Justice, 1996).
This included in-service training programs for staff members of their emergency departments and ambulatory care facilities (National Institute of Justice, 1996). In 1994, 83 organizations, including the American Nurses’ Association and the American Bar Association, met to identify gaps and barriers between the health care delivery and criminal justice systems in dealing with family violence cases.
Among their recommendations were the following: a mechanism for community professional coordination in assessment to maximize family safety; the creation of community-based family violence coordination councils; and the need to establish, in every community, a comprehensive, culturally sensitive, and accessible intervention system for family violence that links health, justice, mental health, social service, and educational systems (National Institute of Justi! ce, 1996).
In addition, the American Medical Association (AMA) published guidelines for Health care professionals to use in identifying domestic violence victims. Violent families are easy to describe but difficult to explain. Research on family abuse has, on a consistent basis, found that the phenomenon is associated with intergenerational transmission, low socioeconomic status, social and structural stress, social isolation, and personality problems or psychopathology (Giles-Sims, 1983).
Traditional theories on the causes of domestic abuse focus on such factors as people’s individual characteristics and life experiences, including the presence of problems such as social and structural stress, social alienation, unemployment, poverty, substance abuse, past child abuse, personality disorders, psychopathology, and depression (Giles-Sims, 1983). However, theories centered on these variables fail to explain why the majority of the population that does not experience domestic abus! e, whether as a victim or a perpetrator, are not affected by these variables.
Additionally, research has demonstrated the elimination of personal problems, such as the ones listed above, does not contribute to ending domestic abuse in a relationship. Nevertheless, for the purpose of framing particular studies of domestic abuse, these theoretical approaches are still important. Due to each theory’s weakness, it is important for researchers to adopt a theoretically holistic approach. The fact that each case of domestic abuse is somewhat different form another calls for using a variety of theoretical orientations to better examine the nature and extent of this pressing problem.
While domestic abuse can be studied through “mental lenses” that are psychological or sociological in nature, it is important also to examine this issue from a medical/public health perspective. While many theories have been proposed to explain the causes of family abuse, one of the most useful has been th! e social learning theory. Bandura (Langley, 1977) proposed that learning be composed of both a modeling component and “reciprocal influence”. The latter suggests that we can shape our futures by influencing our environments.
In explaining how social learning theory explains family abuse, O’Leary analyzed the effects of modeling on behavior, the role of stress, the use of alcohol, the presence of relationship dissatisfaction, and aggression as a personality style (National Institute of Justice, 1996). Modeling involves the observation by the child of physical aggression by the parents or the direct experience of having been physically abused. In a study of wife abuse and marital rape, it was found that viewing parental violence was equally important in creating a future pattern of abuse as the direct experience of child abuse itself.
Modeling, therefore, increases the likelihood that one will use violence in order to handle interpersonal difficulties (National Institute of Just! ice, 1996). Extensive literature exists on the relationship between stress, frustration, and aggression. Stress alone does not cause violence, but it may be a stimulus that serves to arouse some individuals. Overall, abusers generally tend to possess an aggressive personality style. Consequently, people possessing this trait are more likely to get angry than others and may actually get angrier more often than others.
Research suggests that there may be two important aspects to the relationship between family abuse and alcohol. Very often, the abusive behavior of the perpetrator is permitted and excused by the victim because the perpetrator was under the influence of alcohol. On the other hand, alcohol use by victims leads to a numbing effect as well as feelings of powerlessness. Domestic abuse typically follows a “cycle of violence” pattern. There are three phases in the cycle of violence: tension-building, acute battering and the honeymoon phase. During the tension-building p!
hase, the batterer becomes increasingly moody, hostile and critical of his partner. Minor battering incidents may occur. During the acute battering phase, the batterer is likely to assault the victim. Major assault of the victim, physically and psychologically, usually distinguishes the acute battering incident from the minor battering incidents that may occur during the tension-building phase. Shortly after the acute battering phase is the honeymoon phase. The batterer may apologize, beg forgiveness, or promise that the violent behavior will never happen again.
An estimated three to four million women annually in the United States are the victims of physical abuse by their intimate partners (Herman, 1997). According to the Uniform Crime Report (UCR) of the FBI, a husband or boyfriend murders 30 percent of women killed in the United States. In addition, violence is the second leading cause of injuries to women ages 15 through 44 years of age (National Institute of Justice, 199! 6). Most aggressors will often attribute their abusive behavior to external causes, while victims attribute the abuse to internal factors within themselves or situational factors about the abuser (e.
g. “It’s only because he has been drinking”). The frequent occurrence of victim self-blame is reinforced by social attitudes that are responsible for often blaming the woman for inciting the abuse or not leaving her abuser (Herman, 1997). There are numerous answers to the commonly asked question of why a woman would stay in an abusive relationship. For many women, no other sources of financial support or housing exist. The responsibility of childcare further complicates the problem. The most serious reason for concern is the fear of retribution by the abuser.
Batterers frequently threaten to kill the woman or other family members if they tell anyone that they are being beaten. Despite the abuse, a woman may still love her partner and, consequently, will lie to protect him. Many vic! tims possess low self-esteem caused by repeated abuse, both physical and emotional, and believe that they don’t deserve help. Finally, the pure fact of being embarrassed or ashamed may be sufficient reason for the victim to stay. The term domestic violence against men causes many Americans to react with disbelief. Abused husbands are a frequent topic for jokes.
Family abuse is directly linked to status in the family and socialization. There are many serious effects of society’s reluctance to consider the potential for domestic abuse by female. In our society, a large number of girls are told to slap a boy if he gets “fresh”. Movies and television programs display scenes of women punching and slapping men with complete impunity, while the viewer usually reacts with support for the women’s character. While a slap is usually a harmless act, it is important to consider that a slap is still a violent act.
A common question exists when examining domestic abuse against men: if men ar! e usually bigger and stronger than women, then why don’t they try to protect themselves: It is important to look at this issue from a child development standpoint. At the same time that girls are being taught that it is acceptable to slap a boy, boys are being told to never hit a girl. The number of cases and the severity and pattern of the violence used against the victims are the major factors differentiating men’s violence against women from the violence of women against men.
The civil protection order and the criminal court process are effective tools for protecting almost all heterosexual male victims because women rarely attempt “separation violence,” the violence that results as the victim attempts to leave the abuser (Herman, 1997). Why do men stay? Although they may not be victimized if they leave their spouse, there are many reasons why abused men stay in their violent homes. Abused men, like abused women, fear that if they leave their spouse, the abuse that they hav! e encountered may be directed against their children.
Additionally, many men are hesitant to leave since women get physical custody of children in a large majority of divorce cases. They may also fear that the courts will limit children visitation and access. Deciding to leave an abusive relationship is just one part of the problem for an abused male. Another part is choosing where to go since very few shelters exist for them to find refuge. A variety of programs exist to help abusive men control their violence more effectively, however, finding comparable programs that exists for violent women is an extreme challenge.
Resources and facilities that deal with combating domestic violence are scarce due to the limited funding of social services. Therefore, it has been suggested that some women’s groups are fearful that the small amount of funds that exist for assisting abused women may be further lessened if the American public recognizes that men are also abuse victims. Recogniz! ing men’s victimization does not mean that we must deny that women are victims. In fact, groups and agencies that assist abused women could also extend their services to aid battered men and vice versa.
The health care system can play an important role as an intervention point. As changes take place in the manner by which health care is delivered, health service researchers have begun to examine ways of reaching out to individuals who require special attention or care, that are unable to obtain it. This approach has also been applied to domestic abuse victim health services. With the number of injuries hat domestic abuse causes annually, the health care system has begun to see itself as an important link in helping ht victims.
The health care profession is in a position to identify abused victims, administer the proper care they require, and refer them to necessary social services. Unfortunately, numerous articles report that many health care professionals do not perform these! services for battered women, especially in the emergency room. Using ethnographic techniques, Herman (1997) concluded that physicians who explored for domestic abuse in the health care setting felt the procedure to be similar to “opening Pandora’s box”, in fact, 18 percent of the physicians interviewed used that actual phrase.
The physicians participating in this study (the majority of whom were family practice specialists) reported such problems as lack of comfort in dealing with the issue, fear of offending the patient, a sense of powerlessness, loss of control, and time constraints, all of which constitute barriers to domestic abuse recognition and intervention in cases of domestic abuse seen in the primary care setting (Herman, 1997).
Analyzing research that investigates health professionals’ perspective of domestic abuse helps to confirm the startling reality that exists for victims seeking assistance. Sadly enough, as severe a health threat domestic abuse poses to women! , many victims have been, or are currently, misidentified or met with apathy by health care professionals. This phenomenon is due to many factors, the most common of which includes inadequate training (many training programs do not even discuss domestic abuse) and tendencies toward feelings of “victim blaming”.
Many health care professionals adopt the stance that domestic abuse is a problem that falls outside the spectrum of their job description. These professionals view the ideology of the family as a private domain and believe difficulties inside the home can and should be settled by the family members themselves (Langley and Levy, 1977). Assessment of abuse, whether in female or male, requires a high degree of suspicion during the assessment of the patient. Sadly enough, physicians fail to always recognize and/or acknowledge the source of repeated injuries.
One study found that 35 percent of female emergency room patients are treated for symptoms related to ongoing abuse, ! but only approximately 5 percent of the women are identified as victims of domestic abuse (National Institute of Justice, 1996). In 1992, the American Medical Association published Treatment Guidelines on Domestic Violence. Aside from assessment, suggestions for the physician to follow in the interview of the victim are mentioned as well.
These include: Physicians must ask direct, specific questions to determine the occurrence or extent of abuse since many women do not recognized that they are battered; Consider the possibility of assault when a victim’s explanation of an injury does not seem plausible, or when the victim has delayed medical treatment; The patient may appear frightened or nervous or exhibit stress-related symptoms in addition to physical injury; Maintaining a complete and detailed description of the event, in the victim’s own words if possible and of resulting injuries, including photographs if applicable; Being aware that the severity of current or past injur!
y is not an accurate predictor of future violence, the patients safety should be discussed before leaving the physician’s office or treatment center; Being aware of local resources to make appropriate referrals; A physician who treats a victim and does not inquire about domestic abuse or accepts an unlikely explanation for the injury could be held liable if the victim returns to the abuser and is injure again. Aside from medical and psychiatric treatment for injuries, potential victims of abuse can be given information and counseling form the health care provider in order to prevent further victimization episodes. Patients can be informed about the risk factors involved that would increase the chances of serious harm to them.
Psychological counseling, administered by either the primary care provider or a mental health professional, can assist the patient in ending personal relationships with abusive individuals. Additionally, the patient can be provided with telephone numbers ! and encouraged to contact existing community resources such as crisis centers, shelters, protective service agencies, or the police department if there is fear of injury National Institute of Justice, 1996). It’s amazing to me that of all crimes in today’s society; domestic violence is the one that is still on the rise. It is time to take domestic violence seriously and combat it aggressively.
In order for “positive change” to occur, our legal system needs to protect the battered and not the batterer. A majority of battered women are murdered if they try to leave an abusive situation. Why is that? Because they don’t have the protection they need. The criminal justice system needs to start a victim relocation program for domestic abuse victims. This would ensure their safety and allow them enough courage to leave a horrible situation. In a nation that detests racism and protests animal cruelty then why are women and children still subject to torture and violence in their own ho! mes at the hands of their husbands and fathers? In a politically correct world too many of us still view women and children as inferior, as property.
The media portrays women as sex symbols and often with a very noticeable lack of intelligence. Often doctors turn their backs on damage left as the result of abuse because of the fear of embarrassing their patients (National Institute of Justice, 1996). It is time to declare war on domestic violence. Domestic violence will always be a part of our culture. Women are still not considered equal and historically it was acceptable to beat your wife if she was out of line. With today’s broken marriages and extensive abuse of alcohol and drugs, the matter will only get worse. If strong initiatives are not instilled now, there will be many unnecessary deaths due to the rise in abuse.