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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.sourcemaine.com/gift/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.
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