"Doctors Have Best Chance to Stop Domestic Violence,"1 was an August 25, 1999 editorial in the Seattle Times that caught my eye. Doctors in Washington state were being trained to routinely ask their patients, "Do you feel safe in your relationship?" Because of that question, lives were being saved.
Lives were being changed. Due to prompting from doctors, patient calls to crisis lines and shelters suddenly (and dramatically) increased. Abused women and children were being connected to the support system they needed through their doctors. Many patients, because of their doctor's intervention, were discovering how to get help before ending up in the emergency room - or the morgue.
I was moved by the Times editorial, because I remember what it was like when I was caught in the quicksand of a domestic violence relationship years ago. Due to the enormous strain of living with abuse, I became severely depleted and developed health problems for the first time in my life. I turned to acupuncture for healing. However, because I never had marks of physical injury showing, no one ever asked me about abuse. I was too embarrassed and afraid to tell. Believe me, the expression "Don't ask, don't tell" didn't originate with gays in the military. It began with domestic violence, which is probably the most taboo subject in health care.
Though today I am completely recovered from that experience, I often wonder how much more quickly my healing would have begun if only the practitioners I'd seen in those days had been educated about domestic violence. For example, there were times when I got in my car to drive away, but I always returned because I felt I had nowhere to go. Ironically, one of the largest shelters in the nation was located less than five miles from my home, and I didn't know about it. If one of the practitioners had recognized me as a victim of abuse through routine screening and had referred me to the shelter, I would have gone. Once there, I would have been paired up with an advocate who could connect me with a support group; individual counseling; legal counsel; financial help; transitional housing; and even help navigating the criminal justice system. If the people who had treated me in the past had known how to recognize abuse and appropriately intervene, I am certain I would have gotten out much sooner, and the damage to my health (and my child) would have been far less.
How Domestic Violence Impacts Health
Definition: Domestic violence is a pattern of assaultive and coercive behaviors, including physical, sexual and psychological attacks, as well as economic coercion that adults or adolescents use against intimate partners. Most victims are women, as women are five to eight times more likely than men to be victimized by an intimate partner.1
According to FBI data, four women a day are murdered by a male partner.
Homicide is the second leading cause of death for women aged 15-24.
Family violence kills as many women every five years as the total number of Americans who died in the Vietnam war.
37% of all women who sought care in hospital emergency rooms for violence-related injuries were injured by a current or former spouse, boyfriend or girlfriend.3
Abuse by a husband or intimate partner is the leading cause of injury to American women between the ages of 15 and 44.4
Physical abuse of women resulted, in 1998, in more injuries than rape, muggings and auto accidents combined.5
Injuries during Pregnancy
More than one-third of pregnant women are battered.
Battering during pregnancy is the leading cause of infant mortality and birth defects.6
29% of all women who attempt suicide were battered.7
37% of battered women have symptoms of depression;8 46% have anxiety disorders;9 and 45% experience posttraumatic stress disorder.10
50% of men who frequently assault their wives frequently assault their children. Domestic violence may be the primary cause of child abuse and neglect fatalities in the U.S.11
Children who witness domestic violence are more likely to have depression, anxiety and violence toward peers,12 and are more likely to attempt suicide; abuse drugs and alcohol; run away from home; engage in teen prostitution; and commit sexual assault crimes.13
With the exception of statistics on fatalities from Dawn Bradley's The Domestic Violence Sourcebook, all other facts were excerpted from the "Health Care Response to Domestic Violence Fact Sheet" produced by the National Health Resource Center, a division of the Family Violence Prevention Fund (www.fvpf.org).
U.S. Department of Justice. Violence by Intimates: Analysis of Data on Crimes by Current or Former Spouses, Boyfriends, and Girlfriends. March 1998.
Bradley D. The Domestic Violence Sourcebook. Lincolnwood, IL: Lowell House, 2000, p. 7.
U.S. Department of Justice. Violence Related Injuries Treated in Hospital Emergency Departments. Michael R. Rand Bureau of Justice Statistics, August 1997.
Bradley D. The Domestic Violence Sourcebook.
National Women Abuse Prevention Project research, 1998.
Parker B, McFarlane J, Soeken K. Effects on maternal complications and birth weight in adult and teenage women. Obstetrics and Gynecology Sept 1994;84:323-328.
Stark E, Flitcraft A. Killing the beast within: woman battering and female suicidality. International Journal of Health Sciences 1995;25(1).
Housekamp BM, Foy D. The assessment of posttraumatic stress disorder in battered women. Journal of Interpersonal Violence 1991;6(3).
Gelles RJ, Harop JW. Violence, battering, and psychological distress among women. Journal of Interpersonal Violence 1989;4(1).
Housekamp and Roy, 1991.
U.S. Advisory Board on Child Abuse and Neglect. Firth Report. Washington, DC: Dept. of Health and Human Services, Administration for Children, 1995.
Jaffe P, Sudermann M. Child witness of women abuse: research and community responses. In: Stith S, Strauss M. Understanding Partner Violence: Prevalence, Causes, Consequences, and Solutions. Families in Focus Services, Volume II. Minneapolis, MN: National Council on Family Relations, 1995.
Wolfe DA, Wekerle C, Reitzel D, Gough R. Strategies to address violence in the lives of high risk youth. In: Peled E, Jaffe PG, Edleson JL (eds.) Ending the Cycle of Violence: Community Responses to Children of Battered Women. New York: Sag Publications, 1995.
However, back then, nobody was routinely screening for domestic violence. No one knew how. No one even realized it was a deadly serious, gargantuan public health crisis. The first shelters were established in the 1970s by grassroots organizations, but it wasn't until 1992, when Surgeon General C. Everett Koop labeled the epidemic of battering a leading national health problem, that health care providers sat up and took notice. Shortly after, the AMA officially acknowledged domestic violence and declared a national campaign against it. Since then, the AMA has been joined by other groups, including the Association of American Medical Colleges; the American Nurses Association; the American Academy of Pediatrics; the National Hispanic Medical Association; the American College of Nurse Midwives; the Gay and Lesbian Medical Association; the American Psychological Association; Physicians for a Violence-Free Society; and Physicians for Social Responsibility, to name a few.
My state association (the Oriental Medicine Association of New Mexico) recently passed a resolution supporting the training of practitioners in clinical management of domestic violence,2 and I have taught a number of workshops. Many of the practitioners who took the training are now routinely screening in their practices. Hopefully, this interest will continue to spread throughout our Oriental medicine community, and someday our national organizations will join ranks with the others who have taken an active stand against domestic violence. If every graduating student and licensed practitioner were to invest a few hours in learning how to identify cases of abuse and intervene, we could do our job as part of a larger community working to solve a huge problem.
According to Ann Jones, in her dynamic book Next Time She'll Be Dead, "We now know that all institutions to which battered women and children are likely to turn for help - hospitals, mental health facilities, social welfare service, child protective services, police, civil and criminal courts, schools, and churches - must join in a concerted effort to prevent violence before it occurs and to stop it when it does. All these community institutions must be alert to identify battered women and children and to take their part. To greatly reduce this problem will take a united community effort."3
Recently at a website about domestic violence, I saw the following question: "How many doctors does it take to stop domestic violence?" The answer? "Just one dedicated practitioner for each victim of domestic violence." We can make a difference.