Did you know that October was Domestic Violence Awareness Month?

Domestic violence can be done by men or women, occurs with married couples or in informal relationships, heterosexual couples or gay couples. As a doctor, I’ve treated cases among all ethnic groups, among the rich and poor, and in educated and uneducated people.

Yes, fellows, I know that a lot of women make up fake charges, but I also know that a man who slaps a woman in an argument might forget it as a minor thing, but her memory will make it a major assault. So who is right and who is wrong?

But the dirty little secret is that there is a lot of abuse going on out there: and it’s more than a simple slap or push.It often is repeated, and combined with verbal abuse and intimidation.

The victims of repeated abuse with injury is more likely to be a woman: often because she has financial difficulties ie leaves the abusive relationship, or fears losing custody of her children. Also, women tend to be less able to inflict severe injuries because they are smaller than men. Finally,  in many cultures, women are taught that if men abuse them, it is “their fault”.

We doctors get a bit cynical about patients who suffer domestic abuse: the dirty little fact is that when an abused woman comes into an Emergency room,  and we detect abuse and advise them to leave the abuser (including telephone numbers for the local women shelter), often we see little success for our time and efforts.

Too often, even if criminal charges are filed, they will be dropped. All too often, they “love” the man, so when the man l sweet talks the women by swearing they love the woman, and will never do it again, she just drops the charges. So we see them over and over again, often not just for domestic violence but for depression related symptoms or substance abuse because they are trying to numb their emotional pain.

Sometimes the women are right to be cautious: In a fight, hitting back may get you arrested along with your abuser, and of course, women who leave an abusive relationship are often in more danger than if they stay.

The low probability of prosecution in spousal abuse cases, together with the fact that arrest is only a minor nuisance to the abuser who is usually out of jail within a few hours following the arrest, further explains the lack of deterrent effect arrest has on many batterers (Hirschel, Hutchinson & Dean 1992; Lerman, 1992).

Most of the women who do manage to break away from abusers do so after the first abuse, when their self esteem is still strong. Most have family support, giving them financial support, a place to stay, and even physical protection.

But victims of longstanding abuse rarely report it or leave during the episode. Others, we can reach when they come in for “unrelated” problem, and we have time to counsel them and help them arrange an exit strategy when there is less pressure on them. Pregnancy screening for domestic violence is especially important, since often a women will stay with an abuser, but not if he threatens their unborn child.

Alas, partner abuse of pregnant women is not uncommon. (7 to 20% of pregnant women report abuse during their pregnancy in one survey). In my own practice, I’ve had two patients have premature delivery of a dead baby due to beatings, and several others who were abused and left their partners. Neither man who killed the baby by beating their partner was ever arrested.

A lot of these abusers are druggies, alcoholics, and other low life types, but abuse occurs in every level of society. I had a friend, a nurse who was badly beaten by her rich husband who was ashamed to see a doctor for her injuries; and one of our ER doctors was arrested after his wife was beaten so bad that she was admitted to the hospital; she was foreign, and afraid to press charges, but luckily that state had laws that allowed the cops to press charges without her permission.

If the husband/boyfriend uses, drugs, often the cops will find some reason to arrest him (usually they stop his car for a minor traffic offense and find his stash of drugs). That at least gets him off the street long enough for us to help persuade the woman to move in with family or go to a domestic shelter.

But what if the abuser has status in the community, e.g. a well known lawyer, cop or businessman who will have no problem walking in court and denying the abuse? Often if the abused partner has hid the abuse out of shame, or she has withdrawn the accusations or the restraining order out of pity (so he won’t lose his job), she can’t prove her case. The result is that he essentially goes free to abuse again, and she ends up unable to prove the pattern of repeated abuse, and even complaints by family and friends that confirm the abuse might be dismissed as biased.

The helplessness of those suffering from domestic abuse against a criminal justice system that dismisses the seriousness of this crime can be seen in the Palin case:

If even a governor and her family after repeated complaints of domestic abuse and threats to a woman and her family can’t get a cop fired (and his right to carry a deadly weapon revoked), what does that mean for the average minority woman in Alaska who complains of domestic abuse by a policeman?  Presumably, after the politics calms down, someone with a background in human rights and domestic abuse will do an expose on the problem, but don’t hold your breath in the meanwhile.

But a lot of abused spouses will recognize the pattern: He has power, I do not. So he will keep getting off until he kills me, or his next girlfriend.

(FYI: the International Association of Chiefs of Police suggest guidelines for such cases. But I’ll give you a hint: The answer is not to censor the complaining family members for abuse of power).

Sigh.

What will help is if communities start a “just say no” or zero tolerance for domestic abuse.

Communities are encourged to get together and make abusers feel shame, so that even if he pretends the arrest is nothing, his friends and neighbors will be able to reinforce the idea that abusing is unacceptable.

Some tips:

  • Call the police if you see or hear evidence of domestic violence.
  • Speak out publicly against domestic violence.
  • Take action personally against domestic violence when a neighbor, a co-worker, a friend, or a family member is involved or being abused.
  • Encourage your neighborhood watch or block association to become as concerned with watching out for domestic violence as with burglaries and other crimes.
  • Reach out to support someone whom you believe is a victim of domestic violence and/or talk with a person you believe is being abusive.
  • Help others become informed, by inviting speakers to your church, professional organization, civic group, or workplace.
  • Support domestic violence counseling programs and shelters.

Like other social problems that we doctors see but find hard to prevent, it is changing the moral atmosphere of the community that will be the strongest “public health” measure against domestic violence.
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Nancy Reyes is a retired physician living in the rural Philippines. She writes medical essays at HeyDoc Xanga Blog

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