Friday, October 17, 2008

Intimate Partner Violence Challenges Interventions and Solutions: Part 5

This is the fifth post in my series of posts about what I learned at the all-day workshop sponsored by the Mayo Clinic Intimate Partner Violence Education and Prevention Committee.

The final session was given by a Mayo Clinic physician (I'm choosing not to include her name because she is a survivor of IPV and I don't know if her ex-husband is trying to monitor her activities and all references to her). Her session was titled History, Facts and Survival of Intimate Partner Violence.

I don't remember at which point in this session that the doctor talked about the reality that she could still end up as a murder victim because of IPV, but that stuck with me. This possibility is there for her largely because of their children which provides a link between them which her leaving and her divorce can't sever.

The doctor admitted that before she became a victim of IPV she was completely ignorant about IPV and that caused her to be dismissive of women who stayed with their abusers or who returned to them. Her family life as a child was ideal and IPV wasn't something within her sphere of experience. She expected the same type of family life she knew as a child when she married. She didn't get what she expected. But those around her thought she did.

Her assumptions of what she would do in those women's situation were far different than the reality of what she did when she became a victim of IPV.

She and her husband were active in the community as a couple and he appeared to be a devoted husband. But the truth in private was far different than the facade, at least most of the time.

Her husband was thrilled when she became pregnant, but the first time her husband's abuse became physical was during that wanted pregnancy. Along with this physical violence came sexual violence which she didn't immediately identify as rape, but which at times caused her to go to her doctor because of her concerns about the impact of his violence on her pregnancy.

One time during her pregnancy she had bruises on her belly on a day she had an appointment with her ob/gyn and she went into the appointment ready to open up to her doctor about the abuse. Her doctor saw the bruises and immediately looked away from her belly and from her. That shut down all possibilities of discussing IPV and it's impact on her safety and on her pregnancy.

Like many abusive relationships there were 3 clear phases her husband cycled through. Escalation of tension, violence, honeymoon phase.

In that honeymoon phase he was the man she'd fallen in love with. When she recognized that he'd switched to the escalation phase she learned that if she quickly did something small to irritate him, like skipping doing the laundry, that would trigger a premature switch in him to violence and because his tension was low so was his violence. Then the cycle would begin again.

I noticed through her descriptions of her marriage that the tension built when she avoided doing anything which bothered her husband.

The tension didn't build because she was being hostile or mean to him and he was working to hold his anger in until he could control his anger no more. Yet this is the stereotype many non-violent people have about IPV because of their assumptions about what it would take for them to be violent.

This deliberate behavior by IPV victims which sets an abuser off is often described as a cause and is frequently condemned as a contributor to the abuse. But I believe it is an act of self-defense since it is better to have a man rage verbally and throw dirty laundry than to wait until the abuser's internalized pressure is so high that the level of abuse required to relieve all that pressure will result in physical injuries or death.

The dangerous thing about this self-defensive strategy is that it can be used by the abuser to justify the response. This helps abusers to rationalize that they are the victims. Look at everything she intentionally did wrong. This self-defense effort can also be used by others, such as police or family court officials, to view the relationship as co-abusive.

The best way to deal with someone who is cycling through abuse this way is to get out, but other than during pregnancy, someone in an abusive relationship who is planning to get out and who is actually leaving is at the highest risk of being murdered.

No wonder victims of IPV need a danger assessment, referrals to experts and a safety plan. This is tricky stuff with potential landmines everywhere.

This cycle of abuse for her abuser was similar in many ways to the cycle of sexual arousal. The sexual tension rises, sexual activity occurs and then there is the post-coital euphoria. Only instead of sex, this cycle feeds off the experience of violence.

The act of being violent is the emotional and physical payoff for the abuser which leaves behind this lingering feeling of self-satisfaction.

It's sad that anyone could need to be violent, emotionally or physically, to feel self satisfied. That indicates that this person can't get to self-satisfaction in healthy ways. No wonder her husband hated it when people praised her or called her doctor.

When people would greet her warmly at the mall, she knew she would pay for that when they got home. After telling this story, she apologized to anyone she rudely turned away from in public in her effort to to reduce the violence directed at her.

As I think about that behavior I suspect her ex-husband's abuse on those days was designed specifically to make her be rude in public so that he would appear to the people who knew her to be a better person than his wife. This also provides at least one of the reasons why victims of IPV are frequently anti-social. They often need to be to mitigate the violence.

While people who saw her at work didn't know that after she became a parent her husband's rages would cause her to bundle her kids up multiple times a week and take them to a local motel. Once she was sure her husband was asleep she would return and work feverishly during the night to get the house in order so that everything would be perfect by the time her husband woke in the morning.

She admitted that because of her beliefs about marriage she likely wouldn't have left her abusive husband if it hadn't been for her children. The first time one of her children spoke up to try to protect her she knew she had to leave even though she still loved her husband.

She didn't stick around to see if or when her husband would turn his violence on their children.

Because of her profession and her connections she had the resources to get out without using IPV resources. She had been isolated on a personal level, but she didn't have the other barriers which other IPV victims such as Kerri Robinson had.

Because she left before her husband could think of turning his abuse toward their children, the abuse and the child custody were considered by default to be separate issues. If they were connected, the responsibility for proving this was her responsibility.

In the custody process, she paid to have an assessment done to assess the risk to her children. She selected a fellow Mayo doctor who was an expert in the field but whom she'd never even met prior to the first appointment. The judge threw that assessment out because obviously the report was falsified since she and the expert were both Mayo doctors.

Without any proof, she and that other doctor were effectively declared to be liars and co-conspirators.

So she had to pay to have a second assessment done by a doctor in another city and the judge threw that assessment out as well because the judge refused to believe that the second assessment which confirmed the finding of the first assessment could be true.

Again there was no evidence that this assessment was false.

I'm sure that this woman and her husband's public image as an ideal couple helped convince the judge that she was just another vindictive woman using child custody and a false allegation of domestic abuse to gain revenge on her ex-husband.

This judge's unfounded declaration in turn helps other people support their claims about the high number of false accusations of abuse which have been proven in family court. This is a reminder about why the spectrum of prevention is so important.

This is also a reminder for me about why when people rant about "women lie about rape and abuse" that we need to point out that victims of rape and IPV are regularly subjected to false allegations from those who are violent and from those who are in positions of power such as the police and judges.

Those false allegations against victims of IPV don't cease to exist simply because they are not accompanied by criminal charges.

Finally, the doctor told us that what she's learned through her own experience with IPV has led her to be a better, more compassionate doctor. She openly and routinely screens her patients for IPV during exams and makes it clear that the doctor's office is an appropriate place to discuss interpersonal violence.

As illustrated in an earlier session IPV has serious health consequences. If doctors treat the symptoms without being aware of the cause, or a major contributor, they are going to be less effective.

In this final part, I want to add information which wasn't part of the workshop.

One of the issues raised in various sessions in the workshop is how often IPV victims cannot expect their abusers to be charged with a crime or the crime which can be proven is considered a minor crime. In 2005, Minnesota law was changed so that strangulation during domestic abuse became a felony offense.

This is a law which needs to be passed in all jurisdictions. Just as we should take it seriously when people talk about suicide or act in ways that are suicidal, we must take it seriously when people talk about murder or act in ways that are murderous.

Choking another person is dangerously close to murder even when the hold is released before the other person dies.

I want to close by thanking Mayo Clinic and all those involved in this educational effort for this workshop. It was not only needed to raise awareness about IPV, it provided practical information which helps health care providers give first-class service in an area that is too often ignored until it is too late.

There are many more health care providers still in need of this type of top-notch education so this should be a model for education sponsored by non-Mayo health providers.

Here's part 1, part 2, part 3, and part 4 if you missed them.

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posted by Marcella Chester @ 1:09 PM   1 comments links to this post


At March 14, 2009 6:48 AM, Anonymous Anonymous said...

this is a very wonderful story about a women who is physically abused by her husband which is not less than a rape. She could not meet people in the malls, she was a doctor outside house which a very rupeted position but in home she was a victim of IPV.


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