BOOK REVIEW – Domestic Violence & Mental Health

The following post reviews Howard, Feder and Agnew-Davies’ book, Domestic Violence and Mental Health (2013), and highlights several points that relate to a core Thematic Area: The impact of domestic abuse on survivors.

Date Published: 2013
Authors: Howard, Feder & Agnew-Davies
Full Citation: Howard, L., Feder, G., & Agnew-Davies, R. (Eds.). (2013). Domestic violence and mental health. RCPsych Publications.

As the title suggests, this book examines the connection between mental health and domestic violence. The authors review international literature on the topic of domestic violence, and find “there is a high prevalence of intimate partner violence among men and women across all diagnostic categories of mental disorder.” (Howard et al, 2013, p. 18-19). In fact, research suggests that men and women who suffer from severe mental illness are 12 times as likely to experience violent victimization (of all types) as compared to the general population (Howard et al, 2013, p.22).

They also explain that not only are men and women who suffer from mental health issues more likely to be victimized, all victims, regardless of their mental health, are at an increased risk of developing and experiencing mental disorders. This is somewhat at odds with the research found in Herman’s research influential book Trauma and Impact, which notes the common misdiagnosis of domestic abuse victims’ PTSD symptoms as personality disorders (Herman, 1997, p.117).  The authors do note that “exposure to psychological abuse can be more strongly and uniquely associated with PTSD symptoms than physical abuse” and that, “the impact of domestic violence has been thought to have psychological parallels with the trauma of being taken hostage and subjected to torture” (Howard et al, 2013, p.23), which is consistent with Herman’s description of the chronic trauma caused by incidents of captivity, whether by physical or psychological means. (Herman, 1997, p.116)

Women abused by their partners are up to six times more likely to misuse or develop dependency on alcohol and drugs; this is often undertaken as a coping mechanism for dealing with the chronic experience of coercive control and manipulation (Howard et al, 2013, p.24). Other victim coping strategies outlined by this book include:

  1. Legal strategies – Calls police; contacts solicitor; seeks injunctions
  2. Formal help-seeking – Approaches statutory agencies (healthcare, Social Services, housing) or voluntary organizations (refuge, helpline, advice centre)
  3. Informal help-seeking – Talks to friends, family; asks neighbour to call police; asks relative to intervene, directly (to speak to abuser) or indirectly (to be present)
  4. Escape behaviours – Walks away, barricades a room; flees house; goes to public place with CCTV; runs to mother’s house
  5. Separation – Moves out; applies for divorce
  6. Hiding – Tries to keep address of home, work or school secret; disguises appearance; changes name
  7. Appeals to abuser – Talks to ‘calm him down’; asks him to promise to stop; asks him to explain; tries to distract or divert
  8. Compliance – Anticipates abuser’s demands: does things to please or avoids doing things she believes might trigger violence; complies with demands (e.g. has sex ‘to keep the peace’)
  9. Resistance – Answers back; threatens action (e.g. to call the police); attempts suicide
  10. Self-defence – Passive (blocking, resisting) and active (striking)
  11. Manages children – Asks children to call police, to seek help, to leave; asks children to comply to protect against abuse
  12. Personal – Dissociates; relies on religious convictions

(Table 4.2 Common Survival Strategies, Howard et al, 2013, p.54)

To compound barriers to leaving already inherent to the plight of domestic abuse victims (See Power and Control Circle, below), only 10-30% of recent violence is currently identified and asked about in clinical practice. To be sure, the barriers to disclosure can be powerful, including intimidation and coercion by the perpetrator, pressure from family members to remain in the relationship, and the fear of judgment by the victim’s wider community (Howard et al, 2013, p.29-31); all of which serves to amplify the wicked nature of this problem. While the victim’s entrapment may have no physical barriers, leaving an abusive situation can for some seem an insurmountable challenge.

Power and Control Wheel

Obtained from:

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