| 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.
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©1998 by The American Academy
of Experts in Traumatic Stress, Inc.
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