| Introduction
Violence is an
increasing problem in our society. Police and
social scientists have long been concerned with
the level of violence in our streets. Juvenile
specialists have noted the link between violence
at home and the increased likelihood of adolescent
crime. Of the adults that the courts have remanded
to me for treatment, the majority have come from
emotionally or physically abusive homes. Even
witnessing violence can leave emotional scars
as deep as being the recipient of violence.
In this social
context, battered women deserve a special focus.
The battered women themselves are of course the
primary victims. But the secondary victims are
their children. Boys who witness their mothers
being battered are more likely to commit acts
of violence themselves. Girls who observe domestic
violence are more likely to tolerate abusive partners
as adults, thus subjecting another generation
to the same sad dynamics.
So, how do we
intervene? The answer is related to questions
that colleagues and I have often asked ourselves
and each other: Why do battered women tolerate
the abuse for so long before seeking help? And
why, even after receiving help, do they so often
return to their abusive partners?
In her ethnographic
study, Patricia Gagne (1992) writes of Leah and
her abusive husband Andy. After years of violence
at Andy's hands, Leah left. A shelter worker helped
her relocate. But after several months she returned
to Andy. "You know, with everything in my
heart and soul I did not want to come back, and
why I did I really don't know" (p. 409).
This paper proposes some answers to Leah's question.
As the problem is multifaceted, likewise, the
answers are complex. These women are not helped
sufficiently, in part because focus at the ecological
levels of the state and the community reduces
focus on the individual. The reasons for this
inadequate response involve the theoretical constructs
of status, sexism, and (failure to consider) how
systems interact. Systems' interaction explains
how victim behavior and social perceptions interact
to keep even helpful emphasis off the victims.
Systems' interaction also specifically acknowledges
mutually interactive aspects of attachment theory
and the biochemistry of trauma--received or witnessed.
Understanding
the Problem
Bell and Jenkins
(1993) reveal the staggering amount of violence
in contemporary American inner cities. Equally
disturbing to these authors was the amount of
life-threatening violence that Black youths witnessed.
They were growing up amid victimization of alarming
proportions. Not surprisingly, they found that
the effects of witnessing violence were cumulative
and that perpetration of violence by the youth
was related to the violence witnessed.
Increasingly,
researchers are recognizing that an environment
of chronic violence and its perceived dangers
causes many children to adapt in dysfunctional
ways. The maladaptive patterns are usefully understood
within the framework of Posttraumatic Stress Disorder
(PTSD), (Garbarino, 1992), a point to which I
will return later. As I noted earlier, girls who
witness battering grow up, in disproportionate
numbers, tend to be abused themselves (Waites,
1993). Another way of viewing this is that people
who have been directly or indirectly victimized
are likely to be victimized again (McFarlane &
van der Kolk, 1996).
So, clearly, one
point of intervention to break this cycle of violence
would involve interrupting domestic violence against
women. In the field of cultural anthropology,
researchers like Jacquelyn Campbell (1992) have
found that, across cultures, wife battering is
linked to male dominance and cultural norms that
tolerate domestic violence. Because of findings
like Campbell's, a solid argument exists that,
at the institutional/state level, part of the
problem is that legislatures are composed primarily
of men--men who are presumably influenced by a
culture that encourages them to view women as
objects of possession (Gagne, 1992).
Status theory
and Marx's theories of power may dovetail here.
Longres (1995) cites an experiment by Wendy Harrod
where subjects deferred to others who they thought
were being paid more. The experiment is used in
support of social exchange theory. It could just
as well support status theory: more social power
flows to those with the most status, a component
of which is material possessions. In any case,
more power and status accrue to those who possess
than to those who are objects of possession, and
Marx was undoubtedly correct to presume that those
in powerful, high-status positions are unlikely
to readily alter their positions (Longres, 1995).
But despite a possible reluctance to alter a status
quo from which they benefitted, lawmakers have
begun to respond to issues of domestic violence.
Still, even as laws increasingly begin to reflect
our national concern about domestic violence,
the rates of battering still climb (Waites, 1993),
and women continue to return to abusers--further
swelling the domestic abuse numbers.
Could more be
done at the ecological level of the community?
Campbell (1992) for one feels that the neighborhood
level should be the focus of our efforts. In small
communities progress was initially slowed by the
patriarchal thinking that Van Soest & Bryant
(1995) found typical in the United States. Workers
at women's crisis shelters have told me that patriarchal
factors resulted in de facto sexism when it came
time to seek funding for buildings or staff. Despite
these formidable difficulties, crisis centers
with predominantly female staff and board members
exist in most communities with which I am familiar.
Still, the rates of spousal abuse show no signs
of leveling, and having a safe refuge hasn't prevented
many women from returning to be revictimized.
I do not mean
to suggest that because neither laws at the state
level nor interventions at the community level
have halted the rise in wife battering that we
should withdraw our attention from either level.
Public awareness campaigns addressing domestic
violence could benefit from better funding at
both levels. And certainly society-wide attention
to poverty could only be beneficial since low
socioeconomic status correlates with domestic
abuse (Whipple & Webster-Stratton, 1989 cited
in Webster-Stratton, 1990).
Nevertheless,
if we are going to shed light on the vexing problem
of why so many battered women put up with abuse
and then return to their victimizers when they
do have a way out, we must examine the individual.
For many Social Workers the discouraging fact
remains that despite better laws and shelter programs,
most of the women they help will return to the
same abuse. We do these women a disservice if
we ignore the problem at the intrapsychic level.
So why isn't intrapsychic
information about victims of violence more widely
assimilated and dispersed? It is not because we
lack a systematic body of research that would
help us understand victims of trauma. Information
about the biochemistry of PTSD, and attachment
theory give us a useful series of lenses with
which to view revictimization. That the information
is not better known to clinicians may be because
of the same theoretical constructs I already examined:
status theory and theories of sexism.
Social Work, a
predominantly female field, has in its recent
history taken a dim view of intrapsychic emphasis,
linking it with patriarchal Freudian thought and
blaming it (among other things) for the perceived
failure of the profession to heed the larger social
issue of impoverishment during the Great Depression
(Simon, 1994). One could argue that assuming an
intrapsychic emphasis would not enhance one's
professional status as a Social Worker.
Perhaps more central
to issues of status and sexism is a legitimate
concern among women that any focus that smacks
of blaming the victim is inherently unjust. John
Longres (1995) elaborates the position of William
Ryan (who coined the term "blaming the victim")
this way: "Social service workers also blame
the victim when they acknowledge the societal
causes of problems but intervene only at the level
of the individual" (p. 8). If the victims
are overwhelmingly female, as in spousal battering,
blaming them for their troubles also becomes the
crassest sexism.
Is there a way
out of this dilemma? Perhaps, but first we must
recognize it as a false dilemma. Looking for points
of intervention is not the same as blaming the
victim. If we feel victims are at fault, we have
no need to intervene; we can justify ignoring
their plight. But if we wish to help battered
women, one possibility is to find ways to enable
them to change patterns of behavior. That would
be genuine self-empowerment. And it does not mean
we have to cease addressing issues at the state
or community level. However, we can only help
individuals empower themselves if we understand
the biochemistry and attachment dynamics of trauma.
Understanding
the Problem at the Level of the Individual
Trauma researchers
have frequently noted the link between trauma
and retraumatization (Browne & Finkelhor,
1986). For our purposes this phenomenon is the
statistical tendency to be a victim of repetitive
trauma after suffering childhood abuse. Briere
& Runtz (1988) found women who had been abused
as minors were more likely to have been in abusive
adult relationships. Diane Russell (1986) noted
in her study that women who had a history of incest
were twice as likely to report physical violence
in their marital relationships as women who had
no such childhood history.
So what may be
happening here? Well, colloquially we speak of
people who seem to crave danger as "adrenaline
junkies." We would be closer to the mark
if we dropped the implied moral judgment and looked
elsewhere than adrenaline. It is true that a frightening
situation produces epinephrine (adrenaline), but
it also triggers the release of endogenous opioids
(endorphins and enkephalins) whose purpose is
to produce analgesia. The ability to inhibit pain
in a traumatic situation is an obvious advantage.
There is, however,
a downside. Our own opioids are as addictive as
exogenous opioids. In an article exploring self-injury
in adults, Thompson and his colleagues (1994)
noted that release of endogenous opioids had the
same reinforcing potential as heroin or morphine.
They speculated that individuals may continue
harmful behaviors to avoid the discomfort of withdrawal.
This fact has led van der Kolk (1989) to describe
the resulting "addiction to trauma"
as a mechanism for understanding the apparently
compulsive behavior of self-abuse that characterizes
many trauma victims. The more flagrant forms of
self-abuse like cutting on oneself or headbanging
may first suggest themselves as addictive behavior,
but allowing someone else to do the damage may
share the same link to opioids release.
Nor does the effect
need to be maintained from childhood until marriage
by continual abuse to retain its potency. When
people with PTSD were exposed to a stimulus that
resembled a trauma occurring two decades
earlier, they developed an opioids-mediated
analgesia that was equivalent to 8 mg of morphine
(Pitman, van der Kolk, Orr, & Greenberg, 1990).
Several women
from physically abusive relationships whom I have
treated have told me of sensing the familiar buildup
of domestic tension, then provoking a fight "just
to get it over with." This response is an
occasional part of the well known cycle of domestic
violence. What is not expected is the answer I
often get when I ask about their emotional state
as the fighting begins. Several women have thought
about it, then spoken of a sense of calm that
obviously puzzled them. Given the numbing effects
of endogenous opioids, their emotional response
to violence may be understandable. Since they
do not understand it, their appraisal of their
behavior usually invokes shame.
And shame is the
bridge to understanding how negative self-appraisal
and attachment theory interact with the biochemistry
of trauma to further perpetuate the cycle of revictimization.
When battered wives were children, those who suffered
abuse at the hands of caregivers were at risk
to endure understandable threats to their attachment
bonds. Disruption to attachment bonds with caregivers
due to neglect or abuse produces distorted identity
schema resulting in "bad me" appraisals.
Not understanding the biochemistry of why they
tolerate abuse or feel paradoxically calm when
being battered leads abused women to feel shame,
which reinforces the negative self-appraisal first
put in place by disrupted attachment bonds. So
an examination of attachment is in order.
We are biologically
programmed to establish a secure bond with our
caregivers. This drive is most pronounced under
the threat of danger--even if the danger is from
our caregivers. Beverly James (1994) uses the
phase "trauma bonding" to describe how
children are forced by trauma to cling in a nondiscriminating
fashion to abusive caregivers no matter what the
cost.
The cost is usually
to self-esteem. Since children must preserve the
attachment bond or the illusion of a pseudoattachment,
they do so by what in object relations theory
is called "splitting," to convince themselves
that their parents are good and the bond is secure.
Since "bad parent-good parent" splitting
creates too much cognitive dissonance without
the aid of traumatic dissociation and amnestic
barriers, a more common split is "good parent-bad
me." This tendency makes more sense when
considering the egocentrism of young children
whereby they attribute things happening to them
as due to their own actions (Piaget, 1962). Years
later many people first traumatized as children
feel responsibility for their own abuse and perceive
themselves to be unlovable or despicable (van
der Kolk, 1996). These dynamics are often encouraged
by abusers who generally refuse responsibility
for their actions and are only too willing to
blame their victims for imagined transgressions.
Once locked into
a "bad me" split, children must selectively
pursue evidence of their unworthiness. The resulting
guilt can only be expiated by punishment. Many
of my abused clients have said that they feel
a vague sense that they will be punished and that
they feel as if they "deserve" such
punishment. If this tack seems a little too psychodynamic
(dare I say Freudian?), then at least it should
be clear how a low sense of self-worth, coupled
with overresponsibility, could lead a woman to
make excuses for her battering husband.
At this point
a reader familiar with the Stockholm Syndrome
might wonder if that phenomenon is relevant to
the discussion. It might be. Several years ago
in Stockholm a bank robber held a woman as hostage
for several days in the bank's vault. When rescued,
the woman denied that her captor was responsible
for her pain. She was in fact quite indignant
at the force the police had used to capture her
assailant. She seemed to be infatuated with the
gunman.
The key here might
be the infantilization of the hostage who was
dependent upon her captor for food, water, and
toilet privileges. Frank Ochberg (1995) thinks
this traumatic age regression (my term, not Dr.
Ochberg's) accounts for the almost primal gratitude
for life's necessities that many hostages feel
if they're shown even a little kindness. He specifically
links the Stockholm Syndrome with the bond many
battered women feel for their abusers.
Lest the above
seem too simplistic a portrait of some battered
women, a portrait that paints them as largely
incompetent, I would add that I have witnessed
the above dynamics in very professionally accomplished
women. Bessel van der Kolk (1996) finds the same
occurrence: "High levels of competence and
interpersonal sensitivity often exist side by
side with self-hatred . . ." (p. 196).
How widely spread
could the above dynamics be? Though overgeneralization
should be avoided, aspects of attachment dynamics
may account for more revictimization than a skeptic
might think. Reviewing previous research, van
der Kolk & Fisler (1994) found that a majority
of children who experienced abuse or neglect developed
disorganized attachment patterns.
Implications
for Practice and Policy
Now that a base
for understanding revictimization has been suggested,
let me begin this section by observing how victim
behavior patterns, mediated by trauma addiction
and trauma bonding, could interact with systems
at the state and community levels to reinforce
victim stereotypes. Looking at the repetitive
nature of victim behavior without understanding
it can lead to reductive labeling. Specifically
I have in mind the terms female masochism and
Borderline Personality Disorder (assigned overwhelmingly
to women). The former term presumes that pain
gives psychological gratification without
understanding the biochemical basis for
the behavior. The latter term presumes an innate
character flaw without considering the traumatic
etiology. It is significant that Herman and van
der Kolk (1987) found that Borderline Personality
Disorder was associated with a history of abuse.
Pejorative labeling
in our culture can only make it harder for professionals
who wish to help battered women to obtain the
legal protection and the immediate aid they need.
But as I have argued, avoiding labeling by refusing
to examine individual behavior keeps Social Workers
from intervening effectively at the level we often
encounter domestic violence: face to face.
What the above
suggests is that in our professional practice
we must educate ourselves about the dynamics and
biochemistry of PTSD. I have found few things
as immediately gratifying to women as when they
truly grasp that their behavior is understandable
and, by implication, treatable; they are not unworthy,
shameful humans. Of course this places the burden
on clinicians to master the therapeutic treatments
used for trauma-based disorders and a burden on
non-clinical Social Workers to know when and to
whom to refer.
At the policy
level we must be prepared to argue for the treatment
intervention time needed to help clients rework
complex attachment patterns and deal with actual
withdrawal from their own opioids. In an era of
managed care it will be a formidable undertaking
to argue for more, not less, financial aid at
the state and local levels.
Recommendations
for Further Research
At this time medications
commonly used to help with withdrawal symptoms
from exogenous opioids are pretty much limited
to Selective Serotonin Reuptake Inhibitors (SSRIs)
like fluoxetine to help with the attendant depression
and benzodiazepines to calm the patient. In any
case, using carefully monitored SSRIs and benzodiazepines
for battered women in shelters would be a useful
pilot study if carefully designed.
Another promising
area could be (are you ready for this?) - acupuncture.
Avants and his colleagues (1995) have shown some
forms of acupuncture to be beneficial for treating
opioids addiction. A pilot study with battered
women could be economically designed.
References
Avants, S. K.,
Margolin, A., Chang, P., Kosten, T. R., &
Birch, S. (1995). Acupuncture for the treatment
of Cocaine Addiction: Investigation of a needle
puncture control. Journal of Substance Abuse
Treatment, 12(3), 195-205.
Bell, C. C.,
& Jenkins, E. J. (1993). Community violence
and children on Chicago's Southside. Psychiatry,56(1),
46-54.
Briere, J.,
& Runtz, M. (1988). Post sexual abuse trauma.
In G. E. Wyatt & G. Powell (Eds.), Lasting
effects of child sexual abuse (pp. 85-99).
Newbury Park, CA: Sage.
Browne, A.,
& Finkelhor, D. (1986). Initial and long-term
effects: A review of the research. In D. Finkelhor
(Ed.), A sourcebook on child sexual abuse
(pp. 143-179). Beverly Hills, CA: Sage.
Campbell, J.
C. (1992). Prevention of wife battering: Insights
from cultural analysis. Response, 14(3)(issue
80), 18-24.
Gagne, P. L.
(1992). Appalachian women: Violence and social
control. Social Casework: A Journal of Contemporary
Ethnography, 20(4), 387-415.
Garbarino, J.
(1992). Coping with the consequences of community
violence. Protecting Children, 9(1),
3-5, 18.
Herman, J.,
& van der Kolk, B. (1987). Traumatic antecedents
of borderline personality disorder. In B. A.
van der Kolk (Ed.), Psychological trauma
(pp. 111-126). Washington, DC: American Psychiatric
Press.
James, B. (1994).
Handbook for treatment of attachment-trauma
problems in children. New York: Lexington
Books.
Longres, J.
F. (1995). Human behavior in the social environment
(2nd ed.). Itasca, IL:
F. E. Peacock
Publishers.
McFarlane, A.
C., & van der Kolk, B. A. (1996). Trauma
and its challenge to society. In B. A. van der
Kolk, A. C. McFarlane, & L. Weisaeth (Eds.),
Traumatic stress: The effects of overwhelming
experience on mind, body, and society (pp.
24-46). New York: Guilford Press.
Ochberg, F.
M. (1995). Understanding the victims of spousal
abuse, [Online]. Available: http://www.giftfromwithin.org/html/spousal.html
[1997, October 3].
Piaget, J. (1962).
Play, dreams, and imitation in childhood.
New York: Norton.
Pitman, R. K.,
van der Kolk, B. A., Orr, S. P., & Greenberg,
M. S. (1990). Naloxone reversible stress induced
analgesia in post traumatic stress disorder.
Archives of General Psychiatry, 47, 541-547.
Russell, D.
(1986). The secret trauma. New York:
Basic Books.
Simon, B. L.
(1994). The empowerment tradition in American
social work. New York: Columbia University
Press.
Thompson, T.,
Hackerberg, T., Cerulti, D., Baker, D., &
Axtell, S. (1994). Opioids antagonist effects
on self-injury in adults with mental retardation:
Response form and location as determinants of
medication effects. American Journal on Mental
Retardation,49, 85-102.
van der Kolk,
B. A. (1989). The compulsion to repeat the trauma:
Re-enactment, revictimization, and masochism.
Psychiatric Clinics of North America,12,
389-411.
van der Kolk,
B. A. (1996). The complexity of adaptation to
trauma: Self-regulation, stimulus discrimination,
and characterological development. In B. A.
van der Kolk, A. C., McFarlane, & L. Weisaeth
(Eds.), Traumatic stress: The effects of
overwhelming experience on mind, body, and society
(pp. 182-213). New York: Guilford Press.
van der Kolk,
B. A., & Fisler, R. E. (1994). Childhood
abuse and neglect and loss of self-regulation.
Bulletin of the Menninger Clinic, 58(2).
Van Soest, D.,
& Bryant, S. (1995). Violence reconceptualized
for social work: The urban dilemma. Social
Work, 40(4), 549-557.
Waites, E. A.
(1993). Trauma and survival: Post-traumatic
and dissociative disorders in women. New
York: Norton.
Webster-Stratton,
C. (1990). Stress: A potential disrupter of
parent perception and family interactions. Journal
of Clinical Child Psychology, 19(4), 302-312.
©1998 by The American Academy
of Experts in Traumatic Stress, Inc.
|
