As health care providers, we empathize with the terror and pain victims of intimate partner violence encounter. We must also empathize with the abiding love they have for their partners.
The question of why a partner stays in an abusive relationship is almost always accompanied by a myriad of accusatory allegations. All too often we hear that victims who stay in violent relationships are “crazy,” or that they are somehow responsible, or worse even, that they provoke and revel in the abuse. We must not surrender to these myths. If we truly wish to understand why these individuals stay in abusive relationships, we must recognize that this question never has a single answer; rather there are a constellation of reasons why individuals stay in violent relationships.
There is a host of psychological and personal reasons that keep individuals in abusive relationships. Above all else, there is an intense paralyzing fear that accompanies the thought of leaving. Leaving is life threatening and thus, “Staying is the lesser of two evils” (Jacobson and Gottman, 1998, p. 49). The fatalness of leaving is supported by research that shows that often the most severe attacks of violence occur immediately after a separation. Even more terrifying is that women are more likely to be victims of homicide when estranged from their husbands (Gelles, 1997). This crippling fear reacts to the psychological trauma battered victims experience after repeated abuse and keeps them trapped. Women who encounter continual physical and emotional abuse have lower self-esteem and thus feel helpless in their ability to protect themselves from further assaults. Their lowered self-worth often makes them feel even more dependent on their partners to survive, further imprisoning them in their violent relationships. The psychological trauma victims endure often manifests as Post-Traumatic Stress Disorder (PTSD), learned helplessness, depression, and Battered Women Syndrome (Gelles, 1997; Jacobson and Gotten, 1998), all of which leave victims vulnerable and passive, in the belief that they are unable to change their circumstances.
In addition to fear and feelings of helplessness, battered individuals are often trapped by economic and sociocultural variables. Many victims of intimate partner violence have limited economic means of defense. Their partner controls every aspect of their finances with the sole intention of creating dependency. Without sufficient economic resources, even basic survival is threatened. Food, safe and adequate housing, medical care, utilities, and child care become additional bullet points on the list of reasons to stay. It is no wonder then that the decision to leave is joined by shame, humiliation, insecurity, and fear. On the other hand, the decision to stay is complemented with hope, loyalty, love, and survival. After physical and emotional assaults, terror, and trauma, victims are left to make the safest choice: to stay.
Cultural influences extend into intimate partner violence and keep many victims bound to their partners. Beliefs about the sanctity of marriage, divorce, gender privilege, and sexual and physical violence are deeply embedded within cultural perspectives. For many victims of intimate partner violence, “Till Death, Do Us Part” becomes a threatening reality. Many cultures believe that violence within the family context is not considered violence at all. As is the nature of the cycle of violence, if one was raised in a home with interpersonal violence, then they come to accept it as normal family functioning. Therefore, why would they leave? Cultural perspectives also lead victims to believe the abuse is justified, further internalizing feelings of shame, guilt, and failure. This not only keeps victims in their relationship, but it also keeps victims silent about the abuse. Regardless of their understanding of violence, victims desperately want the abuse to end. For many battered victims, the question is not necessarily “How can I leave?” but rather “How can I get it to stop?” (Barnett, 2002, p. 343).
As health care providers, we must recognize that victims of interpersonal violence are holding on, steadfastly, to the hope that things will get better. For many of the reasons shared, they need to believe that the abuse can stop. They want to trust that the last apology was genuine. For, despite the abuse, they do love their partner.
Our role is not to convince the individual to leave but to help plan for safety and support our patients along the way. We start by being present, attentive, and compassionate. We do so patiently and with a genuine understanding of their struggle. We withhold judgment and express concern for their well-being. We must meet them where they are, in their life circumstance, held with their fear and trauma, and guide them through. We must remember that the lives of perpetrators and victims are intertwined, and entire families are at stake. The choice to leave is never made in isolation.
As health care providers we must recognize our own limitations yet continue to be supportive and a knowledge resource. We are often the first line of defense. We can support victims of intimate partner violence just by listening and validating. We must, without pressure, help them see options and alternatives for when they feel ready. We must also be familiar with local resources, legal rights, community agencies, and websites in order to help save our patients in crisis. In medicine, we often share stories about the life or death cases that come into the Emergency Room. Let us not overlook the ones that walk in and back out of our clinics.
Barnett O. Why battered women do not leave, Part I. External inhibiting factors within society. Trauma, Violence & Abuse 2000;1(4):343-72.
Gelles RJ. Intimate violence in families, third edition. Thousand Oaks, CA: Sage Publications, Inc, 1997.
Jacboson N, Gottman J. Basic facts about battering: myths versus realities. In: When men batter women. Simon & Schuster, 1998:34-57.