Violence Begins at Home: Understanding and Treating Intimate Partner Violence
There have been many outcries against violence in America, but we often forget that it begins at home. Domestic or, as it’s now called, intimate partner violence (IPV) is alarmingly prevalent, but almost never discussed. More than 1 in 3 American women and 1 in 4 American men are victims of physical, sexual, and/or psychological abuse by a spouse, boyfriend, girlfriend, or ex-partner. IPV is the leading cause of physical injury in American women aged 15-44. Perpetrators of this violence often have mental health problems, and victimization has been shown to cause new onsets of mental health problems, such as depression, anxiety, and post-traumatic stress disorder.
Yet the two dominant mental health fields, psychiatry and psychology, are largely absent from research and treatment relating to aggression, violence, and IPV-related trauma and recovery. Despite its prevalence in the general population, domestic violence is underrepresented in our consulting rooms in part because victims, and especially perpetrators, rarely voluntarily self-identify or seek treatment. Without experience handling domestic violence situations, clinicians can feel ill-prepared and deskilled, lacking knowledge about referral sources, emergent threats of bodily harm, and the accompanying legal and ethical obligations. This lack of presentation in clinical settings contributes to a “don’t ask” scenario. The work presents unique challenges, including safety planning and patients’ minimization of abuse, which may induce feelings of helplessness in the context of significant urgency and danger.
Beyond the “professional counter-transference” is possibly a more personal one. Aggression is a fundamental human impulse, and violence a socially unacceptable manifestation of it. Underlying any violent interaction is the universal human struggle with aggression and its myriad complex antecedents: family and developmental history; self-esteem; power dynamics; fear of abandonment and humiliation; emotional regulation; impulse control; and the capacity for empathy, guilt, and remorse. The possibility that domestic violence exists at the far end of a continuum of aggression that includes our own moments of intense anger is difficult to accept. Evoking deep, psychological concerns, we retreat from domestic violence, drawing a line in the sand between “our” behaviors and “theirs.” With this dichotomizing orientation, moral judgment replaces a psychological perspective. We tend to pity and disdain the victim, and vilify the abuser, abdicating our roles as clinicians and researchers. It is the mandate of the criminal justice system to punish people for violent actions, and of social services to support victims. In recent Commentary published in our nation’s leading journal of psychiatry, the American Journal of Psychiatry, Drs. Chapman and Monk suggest that the fields of psychiatry and clinical psychology, which lead in mind, brain, brain and behavior, have a mandate to understand and rehabilitate all human behavior without prejudice.
We are working with others to towards this end. The Domestic Violence Initiative of the Women’s Program of the Department of Psychiatry provides free psychiatric services to survivors of sex trafficking and intimate partner violence with the generous support of the Chapman Perelman Foundation. Through co-location in the Bronx Family Justice Center, we have partnered with other organizations to contribute to a framework of economic, legal, social and now psychiatric support to survivors, regardless of documentation status or insurance coverage.
Anna Chapman, MD, Psychiatrist and Catherine E. Monk, PhD, Director of Research of the Women’s Program in the Department of Psychiatry and Associate Professor of Clinical Psychology in Psychiatry and Obstetrics & Gynecology, CUMC; Research Scientist IV, NYSPI; Co-Director, Sackler Parent-Infant Project, CUMC
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