(5) Domestic Violence
A framework for understanding
An appreciation of the overall effects of domestic violence and a way of understanding the sort of support needed by those who experience it can be gained by considering them in relation to Maslow’s ideas on human needs, first published in 1954. As a psychologist, Maslow saw human need, not simply as the requirement for food, water, shelter and clothing in order to maintain existence, but as a deeper drive within individuals to create for themselves an adequate and fulfilling life and to reach out for those elements which they felt were lacking in their present circumstances. He argued that people have higher needs and aspirations. Once the basic physiological needs for survival had been at least partially met, they would want to reach beyond these to achieve some measure of safety and freedom from fear, to belong, to connect to others and be accepted by them, to experience feelings of self-worth and self-esteem and to develop their own ideals and abilities. He saw individuals as actively seeking to meet their needs as they perceived them and to care for themselves in whatever way they felt was appropriate: for example, that they would seek safety before looking for the esteem of others. He also argued that the innate ability to do this might be limited by the social and economic circumstances in which they lived and their past and current experiences, which had the capacity to damage or block their capability of taking action.
Interpreting these ideas in terms of the effects of domestic violence, the experiences of the women in this study show that the physical and, in particular, the mental abuse they had suffered, with its uncertainty and the unpredictability of its occurrences, had removed any sense of physical or mental safety and security. The feelings of fear and shame that this induced deterred women from confiding in those around them and this isolation from others was further reinforced by mechanisms of control and coercion. Over time, they had lost confidence in themselves and their sense of worth and self-esteem, accepting the value placed upon them by their abuser and losing their own aspirations. This in turn reinforced isolation and fear, leaving women with only the basic drive to survive and maintain life for themselves and their children. Yet, at the same time, they were taking positive action, as Maslow envisaged, caring for themselves, as far as they could, in terms of safety and, where it could be done without increasing the risk to themselves or others, reaching out and making connections. Safety was also an important consideration in deciding to leave or stay in the relationship. For many women, leaving may be the more dangerous option. They expressed considerable fears as to what would happen if they were located by their abuser. ‘If he finds me, I’m dead ‘was one blunt and probably realistic assessment of the situation, bearing in mind that official statistics show that two women a week are killed by partners or former partners, a figure which has not altered for more than a decade. Research also suggests that women may be at the greatest risk of harm when they are seeking help, or are at the point of leaving the relationship.
Seeing the effects of domestic violence in this way may make it easier to appreciate the extent and the interlinked nature of the difficulties that a woman who experiences domestic violence has to contend with and the factors which may influence her choices and decision-making processes. In terms of Maslow’s ideas, effective support for women who experience domestic violence needs to recognise and reinforce their own ability to take action. It needs to establish a sense of a physically and mentally safe space, to provide a supportive environment where a woman can feel believed and accepted by others and to work with her to rebuild the confidence and self-esteem which will enable her to regain autonomy and control over her life. Support also needs to be reliable and consistent, to avoid increasing any feelings of isolation, or of not being ‘worthy’ of support and may be needed over a considerable period of time. A recent study of a number of intervention projects by Hester and Westmarland has shown that these are all the factors most valued by service users and seen by workers as most effective in offering successful support.
This support may come from a variety of sources: from community projects such as ‘one-stop-shops’; the outreach and support services run by refuge groups and other voluntary organizations; and from advocacy and health initiatives. National and local help lines also have an important role to play both in providing immediate contact and in putting women in touch with other sources of help. Support need not be seen as limited only to specific organizations. It can be crucially important when offered by individuals who may come in contact with the woman or her family in a variety of settings, including education, employment and health. Nor does it need an official position – the everyday contacts which women made with others – at the school gates, for example – were valued as sources of support and ‘normality’.
Post traumatic stress disorder
Research has shown clear links between women’s experience of domestic abuse and a range of mental health problems, including depression, post traumatic stress disorder (PTSD) self-harming behaviours and suicidality. PTSD was originally seen as a consequence of the experiences of combat troops, but has now been recognised as affecting hostages and the victims and witnesses of major disasters. It has also, thanks to the efforts of feminists working professionally in the mental health field, been extended to include individuals who experience rape and sexual abuse as adults or children and those who experience domestic violence, where the long-term nature of much of this abuse makes it more complex and traumatic than a single incident. It is the parallel with the hostage scenario that is particularly relevant to women who experience domestic violence, since they, like hostages, exist in a situation where unpredictable events remove any sense of physical and mental safety. They are isolated from any source of contact except the hostage taker or takers and lose confidence in themselves, their own identity and sense of self-worth, seeking only to survive the experience. Guidance on supporting recovery from PTSD stresses that the first consideration must be the establishment of physical and mental safety in a supportive atmosphere, the rebuilding of self-esteem and autonomy, and links to family, friends, community and wider society.
The advantage of a diagnosis of PTSD is that it directly links domestic violence with its effects on mental health and emotional well-being and can enable a woman to access professional help, including appropriate medication, without feeling that she is, in some respect, personally deficient, inferior or inadequate, as might be the case with a diagnosis such as ‘borderline personality disorder’. However, it can be seen as continuing to pathologise women, focusing on ‘the woman’ and ‘her problem’ rather than taking account of the situation that has caused it, the controlling nature of the abuse and the circumstances in which she may have to continue to live. Diagnoses of this nature are made by mental health professionals, and as Dutton and Whalen have pointed out, the power for recovery may then be seen to lie with the professional counselor or psychotherapist and become medicalised, rather than rest with the individual woman and the sources of support that she chooses. For the woman herself and those around her, such a diagnosis can be seen as a stigma. It may disadvantage her in dealing with potential employers and with professional and statutory bodies. This may also be the case, as Humphreys and Thiara point out, within the legal system, in matters such as child contact cases or residence orders. Although a diagnosis of PTSD can be extremely valuable in enabling the comparatively small number of women who require or can access it, to obtain specialist help, it would seem to be inappropriate as a blanket diagnosis for all women who experience domestic violence. The women who talked to me were well aware of the immense effect that psychological abuse had had on them and were concerned about the problems that this created for them in their efforts to move on. All of them displayed, to a greater or lesser degree, symptoms associated with PTSD, but none of them saw themselves as needing to access professional mental health services or specialist trauma interventions. To see their experiences in terms of Maslow’s ideas, however, provides an alternative approach which mirrors the concepts involved in the diagnosis and treatment associated with PTSD, but can be seen as more appropriate for the majority of women who experience domestic violence. It removes any concept of stigma, pathology or ‘victim blaming’ and conveys a positive and accurate image of women actively striving to overcome difficult personal circumstances, enduring social and economic disadvantage and reacting in an understandable way to what they have been through. This approach both recognises the important role of networks and communities in recovery and adds a spiritual dimension in recognising the importance of higher values and personal development in contributing to the emotional well-being of the individual.
Loss and grief
As the previous sections have shown, domestic violence imposes emotional, physical, social and economic losses on those who experience it: loss of a sense of safety and security, trust in the world around them, personal identity and self-worth, perhaps of physical as well as emotional health, possessions, jobs, friends, family and community. Women saw these losses as having taken place gradually, almost imperceptibly, over the period of a relationship with someone for whom they had had, and often still had, feelings of love and who, at some time, had expressed similar feelings towards them. For those who take the difficult decision to leave the relationship for good, or who are forced to leave, whether they initially go to a refuge or not, there will be further significant and long-term emotional and material losses to face, which may play a crucial role in any decision-making process. This will include the relationship itself, where there may be feelings of shame and guilt, of love as well as fear and the loss of someone who has been the dominant figure in her life and played a major role in shaping her existence.
Leaving may also involve the loss of older children who are already living independently, or those who had to be left behind, of family, friends, any remaining support network, however small, pets, income from a job, or from their partner’s employment. It is also likely to include the loss of a home which they had struggled hard to build up and keep together, often in the face of recurrent destruction of fabric and furniture by the abuser. The significance and impact of these multiple losses has been recognized by many other researchers in this field. For all the women who talked to me, there was the loss of a familiar environment - one which they knew and understood however risky it had become. Many of them had travelled long distances to reach a refuge, either for reasons of safety, or to where there was accommodation available. For them this meant tearing up their roots and losing their own culture and way of life: I cried all the way till when I got here… I knew I was crossing the county and I knew I wasn’t going back there and it was…I don’t know, I don’t know how I felt, I just knew I were upset anyway. I were devastated because I was coming so far away from home and I wasn’t going back and the kids weren’t going back. (Val - victim)
It can be difficult to comprehend the experience of loss on this scale. Women spoke of the need for time and space to take in all that had happened to them, to grieve for their losses and come to terms with their present situation. In listening to their stories, it became apparent to me that the pattern of recovery and rebuilding that they were going through mirrored, in its essentials, the pattern of loss, transition and recovery following bereavement. A number of versions of these progressions have been put forward, but it can broadly be summarized as consisting of three fluid and interlinked phases:
1. An initial impact with feelings of intense shock, numbness, unreality and disbelief.
2. A transition period involving recognition of what has happened, a period of mourning, disorganization and adjustment, with feelings of anger, loss, depression, lack of confidence and intense waves of emotional feeling, often unexpected and uncontrollable.
3. A time of reorganization, recovery, implementing change and building a new way of life.
I have adopted the terms Reception, Recognition and Reinvestment to describe these three phases, as these seemed to me the words which best encapsulated the process occurring within and beyond the refuge setting for each woman. For some of them, a changed understanding of themselves and their role in society and a desire to develop their own abilities took place, during either the phase of Recognition or of Reinvestment. This could be identified in terms of Maslow’s concept of self-actualization and I have described this as Realignment. In discussing the way an individual is likely to move through the phases of bereavement, Worden identified a number of tasks associated with the process, which both assist in coming to terms with the changed situation and require positive action on the part of the individual. The majority of these are emotional tasks: accepting what has happened; mourning the losses; adjusting to a new environment; and dealing with feelings about the person who has died. At the same time there are new and difficult practical issues that have to be faced: realizing that the world has changed; taking on unfamiliar tasks and new roles; dealing with financial and social problems; and seeking a new identity and relationships. Just as in bereavement, these two strands (the emotional and the practical) run in parallel for women leaving an abusive relationship. There is a danger, however, that whereas in bereavement, as Stroebe and Schut point out, the difficulties and stresses of the practical problems may be overlooked, for women who experience domestic violence it is the practical aspects that become emphasized and the parallel and equal need for emotional support can be overlooked. Research and practice in working with bereaved people emphasizes that these phases and tasks are not consecutive and boundaried. They represent a fluid and dynamic process of coping, which will be different in duration and support needs for each person within the context of their personal circumstances. The process will also be affected by any additional traumatic factors involved, as might be the case with murder, the death of a child, suicide, or accident. For women who have experienced domestic violence, it is the effects of abuse, which make it more difficult to move forward – fears over personal safety, the availability of support and the loss of confidence, self-esteem and self-worth. Emotional support, therefore, needs to be directed at meeting these needs, in addition to understanding and working with the grief caused by the losses women have sustained and the practical tasks involved in moving on with their lives. As with bereavement, the rebuilding of their lives is not a speedy or straightforward process. Women are likely to experience numerous periods when they return to their earlier feelings of sadness, confusion and self-doubt, as well as times when they are able to act with immense confidence and courage.
Loss, trauma and recovery
Unlike grieving after bereavement, which today is generally seen as a normal and socially acceptable process, domestic violence is still largely a taboo and stigmatized subject. Despite the efforts of campaigners over the past two decades and the positive approach of government, women are likely to be held back from disclosure by feelings of shame and guilt, particularly as they may be uncertain of the reaction they will get from family and friends, or from any agencies they may contact. Seeing the effects of domestic violence in terms of Maslow’s ideas on human need can make it easier to understand why it can be difficult to reach out for support, or to decide to leave the relationship and why community support is of such importance.
For those who take the difficult decision to leave, there are major material and emotional problems to overcome. Placing these in the context of recovery from bereavement, made more traumatic and complex by the effects of domestic violence, can enable women to see their feelings as normal and understandable, given what they have been through, to locate themselves in a process with an ending and see that they are capable of acting to change things. The framework of understanding provided by these two perspectives can be utilized by agencies and organizations to understand why women may choose to return to, or remain in, the relationship, the emotional and the practical difficulties that have to be faced in staying or leaving and to provide effective and flexible support.
Domestic violence can be physical, psychological, sexual, financial or emotional and these elements will often combine and reinforce each other. It normally follows a pattern of repeating and escalating incidents, whose unpredictability produces a state of constant fear and anxiety in those who experience it.
The majority of incidents are perpetrated by men against women with whom they have, or have had, an intimate relationship.
Violence and abuse may also occur within same-sex relationships, be carried out by women against male partners or former partners, or take place between members of the extended family.
Although physical and sexual violence can cause permanent damage to health, women found that the mental impact of these acts and the emotional abuse of ‘mind games’, coercive control and manipulation were both harder to endure and more difficult to explain to others.
Constant denigration and criticism had led to the loss of self-esteem, confidence and any sense of self-worth, while controlling and possessive behaviors had isolated them from family, friends and other potential sources of support.
Women did not see themselves as powerless or passive within these situations. They took positive action to defuse tension and protect themselves and their children and utilized any opportunities that offered to maintain contact with others.
Using Maslow’s concept of human needs offers a framework for understanding the effects of domestic violence and for effective support giving. It recognizes the positive agency of the woman herself, her own capability to take action and her drive to improve the quality of her life, together with the importance of physical and mental safety and a supportive community.
A diagnosis of post traumatic stress disorder (PTSD) can offer a way for women who need it to access specialist medical intervention, but may be inappropriate for the majority of women who experience domestic violence and may have adverse consequences in dealing with statutory bodies and other agencies.
Women who leave an abusive relationship experience loss on material, emotional and personal levels. The process of recovery from these multiple losses is similar to that following bereavement, with fluid and overlapping phases spanning initial impact, transition and reintegration. The process of recovery is made more complex and difficult by the way in which domestic violence has damaged confidence, self-esteem and feelings of self-worth. Support needs to work with these feelings as well as the difficulties created by the practical and emotional losses entailed in leaving the relationship. For women who experience domestic violence, whether they are in an abusive relationship or have left, support needs to be reliable and consistent, in order to rebuild confidence and trust and a sense that they are worthy of support. This support may need to be accessible on a long-term basis. Any support activity must prioritize physical and mental safety and work with the woman to rebuild her confidence and enable her to take control of her life. Emotional support is as important as practical assistance. Support should not be seen as limited to statutory and voluntary organizations, since individual and community support represent an important resource in recovery.