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Domestic Violence and Mental Health

Domestic Violence and Mental Health

Beautiful Minds Coalition

May 2021- Mental Health Month

It was not the first time he pushed her against the wall and slapped her. It had happened multiple times over their 10-year marriage. Each time, it was precipitated by a small incident like coming home late by about 10 minutes. He would accuse her of having an affair, getting ready to leave him and not caring about him. He would call her heartless and selfish. Sometimes it was more violent than this time. She had to wear long sleeves and extra makeup to cover bruises. He was always apologetic afterward, promising that things would be better; and for a while, they were better. He cleaned the house, fixed favorite meals, planned special trips for her. Slowly but surely, she could see the tension building in him as he started commenting on her work hours and insisting that she account for all of her time away from him. He called her a dozen times a day, to “show how much I care.” He would try to cut her off from her parents and friends, claiming that they did not like him. He wanted control of the bank account, even though he did not work. It was always the same: a period of “a perfect relationship”, followed by a period of tension and then an explosion of name calling, demeaning and violence. What was different this time was that she was prepared for it. She took her car keys, the bag she had packed ahead of time, the emergency money she had put away, the identification cards, credit cards and legal documents she needed and left; going to a hotel where she was pretty sure he would not find her. She was glad she got out and perplexed that it took her so long to take care of herself. She had a Ph.D. in Biochemistry and she thought she should have realized what was happening sooner than she did.

The scenario above illustrates what is called the cycle of violence experienced by many people who are abused by other members of their household. Researched and named by Lenore Walker (1979), the cycle includes three stages:

  • The honeymoon stage in which everything is going well between the couple. Abused people have said, “It is all wonderful during that time. If we got along that well all the time, we would have a perfect marriage.”
  • The tension-building stage in which the abuser starts to get more and more controlling and more and more irritable. He or she is beginning to fear that their spouses are not happy with them and are planning to leave. They start overthinking little things like coming home 10 minutes later than the abuser thinks they should.
  • The violence stage in which the abuser lashes out aggressively in word and/or deed.

It is called a cycle because it occurs over and over, frequently getting more and more violent. After lashing out, the abuser’s fear of abandonment increases and he or she tries to make amends, to keep the other involved in their relationship. The cycle starts over.

Since 1949, May has been designated Mental Health Awareness Month in the US.  As part of the mission of the Beautiful Minds Coalition to raise awareness of mental health issues, this May we would like to focus on Domestic Violence. Recognizing that it is an uncomfortable topic to think about, we invite the Covenant community to spend a few minutes this week thinking about how uncomfortable it is to live in an abusive relationship, if just thinking about it makes us want to look the other way. Consider the following questions:

  • What is domestic violence?
  • How does domestic violence relate to mental health?
  • Are abusers mentally ill?
  • What can a Christian community do about Domestic Violence?

Domestic violence- defined

The Center for Family Justice defines domestic violence as: “…a pattern of coercive, controlling behavior that is a pervasive- life-threatening crime affecting people in all our communities regardless of gender, age, sexual orientation, race, ethnicity, religion, social standing or immigration status.”  It includes physical, emotional, or sexual abuse.

In Texas, family violence is “… Any act committed by one family or household member against another family/household member that is intended to cause physical harm, bodily injury, assault, or sexual assault OR a threat that reasonably places the family or household member in fear of physical bodily harm, bodily injury, assault or sexual assault.”  It can be an act or a threatened act. It includes any members of a household or a member of a family: anybody who has lived under the same roof or who have had a child together, whether they are living together now or not.

It can include physical assault, sexual assault, emotional abuse (name calling, demeaning) or threats to physically or sexually assault of children in an effort to control an adult.

It involves the entire range of abuse and every stage of life, including:

  • Child abuse
  • Intimate partner violence
  • Elderly abuse

Both of these definitions capture an important point- it is illegal to usurp the power of another person, either by physical force or by threat. There are limits to personal freedom and those limits start where the other person’s freedom is impinged on. It does not matter how old the person is, the sex of the person, the religious affiliation, the racial identity etc. What makes violence a crime is the effort to coerce and control another.

At the same time, it raises difficult questions for us as Christians. How are we to respond to and/or support all the people involved in domestic violence? Are we to leave it to the legal system to protect and to punish or do we have a different calling? Can we minister to those who choose to stay in a violent relationship or to those who are violent? If so, how?

Width and breadth of the issue.

The National Domestic Violence Hotline points out that 12 million people a year are affected by domestic violence. They are from every walk of life and every socio-economic category. It is not something that happens to “those people on the south or west side.” It happens in all of our neighborhoods and it is expensive. According to Forbes (2019), one in three women and one in four men have experienced some form of domestic violence and the CDC estimates that the economic costs over the lifetime of these people is 3.6 trillion dollars, Yes, trillion with a “t”. It is highly likely that we all know somebody who has suffered or is suffering from domestic violence. And, the cost in medical care, lost productivity, and criminal justice management is larger than the recent economic recovery package.

Domestic Violence and Mental Health

Two issues we need to consider when thinking about domestic violence: (1) What is the impact of Domestic Violence on the Mental Health of the person being abused? And (2) Is the abuser mentally ill?

According to Women’s Advocates (2020):

  • More than half the women seen in emergency rooms have been abused by their intimate partner
  • These women are frequently diagnosed with depression, anxiety and/or PTSD
  • Traumatic events result in profound and lasting changes in physiology, arousal, emotion, cognition and memory that are not diagnosable as a mental illness but have profound effects on the quality of a person’s life.

A recent literature review in the American Journal of Preventive Medicine concluded that verbal, sexual and physical abuse as well as controlling behavior increased the risk of poor health, substance abuse, depression and developing chronic physical and mental health in both men and women.

The relationship between Domestic Violence and Mental Health is a bit of a which came first… issue.   Longitudinal research on temperament shows that we are born with a level of reactivity that follows us throughout our lives. People who are very reactive to stressful stimuli at one day old, stay highly reactive as adults while people who calmly deal with the problem of reducing stress at day one, continue to react with less reactive later in life. Longitudinal research from Harvard revealed that the baby who yells and screams, thrashing around when an ice cube is pushed against his or her foot on the first day of their life is still thrashing around as a 40-year-old adult.  People who calmly moved their foot to escape the stress of the ice cube were still calmly dealing with stresses as adults.

Recent brain-imagery research on exposure to violence shows changes in the nervous system that make people more aware of risk and more impulsive in responding to perceived risk. The inborn tendency to react to stress can be modified by experience. Exposure to violence is one of the threatening experiences that can change our nervous system, making us more sensitive to threat and more reliant on the in-born, fight-flight response than before we were exposed to life-threatening or violent incidents. It puts us on high alert and, the more threatening experiences we have, the more and longer we are on alert. We do not “re-set” after threatening experiences.  It is this hypervigilance that stresses the domestic violence victim and places long-term wear and tear on our bodies, resulting in poorer physical and mental health. It is this change that results in the attention-concentration problems, relationship problems and problems adapting to change that reduce victim’s effectiveness and leads to an increase in stress related illnesses in abused people. Living on high alert for too long exhausts the body and may result in depression, ulcers, high-blood pressure, heart attacks, strokes and cancer.

The effects on the abused include:

  • Difficulties being productive at work because of problems with attention-concentration
  • Problems with trust that make it hard to develop and maintain a close relationship in one’s personal or professional life.
  • Reduced ability to accurately recognize threats and respond to them appropriately.
  • Problems adapting to change.

In addition to their impact on victims, both temperament and experience contribute to the tendency to abuse others. People who are born with a more reactive temperament are more likely to be impulsive than others and they are more likely than their peers to run afoul of the law in the sense of being harder to discipline. If that discipline is violent itself or if parents are inconsistent in their attention, caring, love or acceptance to the reactive child, that child is likely to have changes in his or her nervous system that makes it harder to control their already minimally controlled impulses.

Abusers and Mental Illness

Historically, the research on the mental health of abusers has determined that they are not mentally ill in the sense that there is a diagnosable and treatable emotional, behavioral or cognitive impairment, like depression, anxiety, a mood disorder or psychosis. Rather, they were described as what mental health professionals call character and behavior disorders, Cluster B. That is, they had a life-long pattern of behavior that interferes with their ability to get along with others. They have been found to have trouble with impulse control, the ability to empathize with others and were thought to be nearly impossible to treat.

The neuropsychological research utilizing brain scans noted above have identified changes in brain structure and function in areas of the brain that control impulses, regulate emotions, and result in immediate and intermediate memory problems similar to people with cluster B personality disorders. The primary association is with borderline personality disorders.  People with this diagnosis are hypersensitive to threat of abandonment and tend to act out aggressively when threatened with loss of a significant other. Additionally, research has shown that up to 85% of Borderline Personality disordered persons are victims of domestic violence, themselves.

Currently, the best interpretation of current research on abuse is that both the abuser and the person being abused actually have diagnosable and treatable conditions.

What we can do as Christians.

A caveat:

Though a conversation with the abused or the abuser has the best chance of influencing either or both, it is important to understand that domestic violence is a difficult, sensitive and sometimes even dangerous topic to engage. Before approaching anybody about the nature of his or her relationship, it is essential that you are on good terms with them, they see you as a caring and concerned person who has his or her best interest in mind, you are able to hear their story in a way that does not condemn either party but makes it clear that the behavior is not good for anybody.

Supporting the abused

The National Domestic Violence Hotline in Austin provides a wealth of information on domestic violence including suggestions for supporting the abused victim. To begin with and of particular importance to Christians is the warning to resist the temptation to “save the abused.” They point out that at the heart of domestic violence is the distribution of power. The abuser usually has usurped the power in the relationship and the abused have little sense of their power- they have been coerced into giving up their ability to affect decisions that impact their lives. Therefore, it is essential that as we support the abuse victim that we do not clone their experience of powerlessness. Toward that end, the Hotline recommends:

  • Acknowledging that their situation is frightening and difficult and that regaining control of their life is likely to be difficult.
  • Not judging them for whatever choice they make- no criticizing or guilting them, especially if they decide to stay with their abuser. Many abused people say, “I don’t want to leave. I just want the abuse to stop.
  • Remind yourself that you cannot rescue them- their decisions are theirs to make. To regain their power, they need to make the decisions that affect their lives. That does not mean that we cannot help them think through the consequences of their decisions by asking questions like, “So, you have decided to ________________. How do you think that will work out?”
  • Do not judge their abuser. There are reasons that the victim and abuser got together in the first place. The victim is likely to have mixed feelings about the relationship and the abuser. Criticizing the abuser is more than likely going to result in the victim defending his or her decision
  • Help them develop a safety plan including identification, driver’s license, car keys, money and important documents and plan for living arrangements if the victim decides to leave the relationship. It is important to remember that the majority of the injuries and deaths happen when a victim is leaving the relationship.  Help the victim think through how to protect themselves from stalking and abuse after they leave.
  • Continue supporting them if they decide to leave and are lonely, scared or upset or if they decide to return to the relationship.

Supporting the abuser

Supporting the abuser is trickier.  Many of them are in Cluster B personality disorders and have identifiable changes in their neurology, it is likely that they will be resistant to change. Their own neurology is normal for them. Many of them have deep wounds of their own, stemming from adverse childhood events, and they are not likely to want to even recognize their hurts much less do anything about them. Therapy for them threatens to overwhelm them and most of their lives, they have developed ways of keeping their pain at bay. Their insistence on complete control of others is a way of not having to deal with their pain.

Perhaps the most important thing about supporting people who abuse is recognizing that their abusive behavior is serving a purpose for them.  If you are comfortable with it and they are willing, you can help them explore the efficacy of their behavior in achieving their purposes. For instance, the abuser in the scenario above had a chaotic childhood in which his mother, a single mother, was frequently gone from home- working to support him and his two sisters. When she was home, she was too tired to engage him or his siblings in any meaningful way. She could not always provide the basics for them and he went to bed hungry more often than not. He felt abandoned and uncared-for.  His abusive behavior came out when he feared being abandoned by his wife. In his heart, he did not believe he could survive without her.

The Washington State Coalition Against Domestic Violence suggests the following guidelines when talking about their relationship with somebody about whom you care and who is in an abusive relationship, either as the abused or the abuser:

  • Recognize your power- you have the ability to influence the people about whom you care.
  • Do not expect immediate change; be patient and persistent.
  • Approach the person with an open-mind, care, and genuine interest.
  • Even though it is difficult, stay connected with the people about whom you are concerned.
  • If you decide not to confront domestic violence, staying in touch reduces the risk because it is hard to keep the secret of domestic violence if you are checking with people regularly.
  • If you find yourself in the middle of a conflict, say something to bring attention to the discomfort like, “Is this the way you two talk to each other all the time?”- raising awareness frequently reduces violence.
  • Have a conversation based on compassion, love and patience.
  • Be direct and focus on behavior not character
  • Make an observation about the behavior that concerns you, ask a question and listen.
  • Do not use the term “abuser.”
  • Use an “I-message”- I notice ______________ when you guys are together. I was wondering what is going on?
  • Abusers often are defensive, make excuses, or blame the other. When they do, switch back to the positive to defuse things a bit: I really love you guys and I believe that you love each other.
  • Expect to feel uncomfortable with the conversation- it is a sign that things are going well.
  • Defuse blaming behavior by recognizing it and limiting the behavior: “Even if what you say is true, nobody deserves to be hit because of it, I wonder how else you guys can handle it when this comes up.
  • If things seem to be getting too aggressive, trust your gut and take care of yourself.
  • It is not your job to change somebody else- it is just about holding up a mirror
  • If you do not think you can confront the situation, get help from a trusted friend or a professional experienced in working with people involved in domestic violence.

If we as Christians are supposed to love our neighbor as ourselves, what if our neighbor is an abuser? What if our neighbor is the man in our scenario and he lives next door?  How do we “say the truth in love?”

Want to know more:

National Domestic Violence Hotline- a one stop resource center on Domestic Violence:

1-800-799-SAFE (7233), or

Family Violence Prevention Services, Inc.

210-930-3669   or 24/7 hotline 210-733-881

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