Domestic Violence: Call for Primary Care Screening and Gender Issues – Part I

In this article, and some to follow, I will provide a glimpse into controversies and progress in the field of domestic violence (DV). Issues of mental illness, cognitive disabilities, personality disorders, unemployment, poverty, gender, politics, the legal system, and education loom large in DV, calling for a biopsychosocial perspective. What better place than Brain Blogger for a look at the subject? Because it is such a tremendously large and complicated topic, I will write about it through different lenses.

I am not an expert in DV, but I have had my share of exposure in my work with federal probation and pre-trial, in chemical dependence, in family therapy, and in employee assistance programs. The way I put together this snapshot, was by monitoring a major discussion list of experts and practitioners in the field of DV, and doing a survey of DV-related research, particularly that concerned with mental health issues.

I’ll start with a very good reason for primary care providers to screen for DV, and an initial look at gender issues.

The number of women being arrested for DV is increasing. They constitute one-fifth of these arrests. There is concern, though, as to how many of them are women who were fighting back. The concern is amplified by the fact that some batterers are able to manipulate the police and the courts. According to authors such as Jackie Campbell, the batterer who succeeds with such manipulation rebound even bolder with a victim less likely to call for help; the danger is greater.

However, statistics showing that over half of violence in relationships comes from women (not danger or physical harm, there’s a difference) could lead one to say that this might be playing out as much to harm men as it does women, especially since the bias is generally against men, who are presumed to be the perpetrators. An expression of this bias developed in clinical thinking in the form of the idea of learned helplessness, in which, through abusive manipulation, women were believed to become unable to effectively defend themselves through escape, self-advocacy, or other means. Research has not supported the idea that this characterizes most women who experience DV. When police encounter women who are fighting with their men, and who are drunk and surly, they are not prepared very well to respond by this kind of bias.

In any case, the research and advocacy on DV calls for routine screening for DV in primary care settings, including maternity settings. The motive for this is to get early intervention, which will prevent violence, save lives, and get help before the DV dynamic becomes more ingrained. According to Jackie Campbell, nearly half of women killed by their partner are seen in primary care settings prior to their deaths, but only 4% of them were in shelters.