SUMMER 1997 - ISSUE NUMBER 40
In previous Winter Solstice issues of Synapse, I reported on physician work within the peace movement as expressed during the congresses of International Physicians for the Prevention of Nuclear War (IPPNW) held in Hiroshima and Stockholm (issues 10 and 18). In this article, I would like to briefly review that work at the global level, then shift to focus on what feels to me like the same work at the individual, family, and community levels in addressing issues of Family Violence at home.
IPPNW's work focused on preparations for nuclear war and presented clear projections to an aftermath in which humanity's relationship to the earth and its constituent species of life would be forever changed in a bleak, terminal way.
IPPNW's success in naming those truths, and bringing those realizations to a large number of people around the world led to its award of the 1985 Nobel Peace Prize. The prize, in turn, led to a raised profile for an organization which swelled to nearly a quarter million members by the time of the Hiro-shima Congress just before the fall of the Berlin Wall. The mere existence of the organization, with its evolving infrastructure of cross-cultural communication, camaraderie and shared vision of a global future, provided hope and an arena of imagination where notions of "medical peacework" might be explored.
By the time of the Stockholm Conference, six weeks after the Gulf War cease fire, it was clear that the destructive distinction between nuclear and "conventional" warfare had narrowed considerably. The explosive equivalent of 8 Hiroshima bombs rained down to destroy a societal, health-care and sanitation infrastructure, leaving 170,000 children under six years of age to die in the twelve months following the cease-fire from the resultant water borne disease epidemics. The air and ground wars together with the oil well fires smothered an extensive area of formerly diverse and fragile marine/desert ecosystems. It was a scene of overwhelming power, abuse, violent oppression and human arrogance.
Consideration of the Gulf War at the Stockholm Congress prompted a broadening of IPPNW's mission beyond its foundation in the prevention of nuclear war in a way that began to reflect the name of its American affiliate, Physicians for Social Responsibility. War (in general), poverty, and pollution were placed within a triangle flanked by peace, development and (a balanced) environment respectively.
If you take the dynamics of power, violence, and oppression found in war, and put them inside a home, or a relationship between people who care for each other, you have Family Violence. Just as the time period between two wars has never been the lasting notion of peace with justice, so too are the time periods between acts of abuse or perpetration of violence within a given family or relationship only a phase of a described pattern of cyclical power and control within those relationships and across generations of families through time.
Violence, and its potential for expression, exists on a continuum which we all share and through which we are all connected to each other. When we are able to work beyond dynamics of "us and them" to own our behaviors and experiences, and gain insights into the nature of that continuum, we will be able to foster movement along it, away from acts of atrocity and toward respect and real healing that can lay evolutionary groundwork for sustained peace.
This perception comes out of two decades of experience and teachings from the battered women's movement, and out of a broad array of collaborative efforts to address violence in the metro area of the Twin Cities of St. Paul/Minneapolis. Minnesota enjoys a reputation for progressive activism and creative approaches to complex problems. In such an environment it has been possible to devise and implement a pilot program to begin addressing Family Violence in the primary care medical setting.
With the exception of child abuse, which was ushered into clinical medicine by Dr. Kempe in the early 1960's, and which has medico legal requirements, family violence has been minimally addressed in medical training if at all 1. In fact, there is a growing body of research evaluating abusive dynamics inherent in medical training 2. Without specific skills and training, without a knowledge base or awareness of prevalence and common dynamics, health-care workers in general, and physicians in particular have been reticent to address issues of violence, neglect and oppression, more easily categorized elsewhere as "social problems."
Since founding the nation's first women's shelter in St Paul in 1974, the grassroots of the battered women's movement have pushed the private reality of women's lives into public consciousness. It challenges a patriarchal society reluctant to pause from its self-aggrandizement and engage in a little sorely needed introspection. In 1976, Nebraska became the first state to declare marital rape a crime and Pennsylvania became home of the first statewide coalition of battered women's programs. By 1989, there were over 1200 shelters and other programs serving more than 500,000 women and children annually. Shelters are filled as soon as they are opened; 7 of 8 women who seek shelter are turned away.
The organizational, educational and communication work of the movement has established an evolving basis of understanding, and set of descriptors common to the experience of battering. The abuse is based in skewed dynamics of power and control, with women the object of control in 95% of cases. Twenty-five to forty percent of all women experience physical abuse in their intimate relationships. Same sex intimate relationships experience the same frequency of abuse. More women are assaulted by their intimate partners than in automobile accidents, muggings and stranger-rapes combined. Incidence of physical abuse is statistically greatest during pregnancy.
The dynamic is cyclical and progressive. There is a buildup of tensions, an explosive release reasserting control, and a "honeymoon period" prior to the next buildup. Left as an increasingly isolated and isolating system, the cycles become shorter, the explosions more violent. Traditional "marriage counseling" in an unacknowledged abusive situation usually serves as a further tool of control for the perpetrator. Alcohol and other mood altering substances are not causative, but often stoke a developing flame. A woman's risk of violent death increases three-fold when she moves to leave an abusive relationship.
Cycles occur not only within a given relationship, but across generations within families as well. Children, whether physically abused or not, learn norms of behavior which they will bring to their schoolmates and later to their intimate relationships. Elders can suffer ongoing abuse at the hands of their longtime partner (and are usually resistant to suggestions that there may be other, "healthier" situations of being) or from their grown children who reverse their experience of childhood.
Violence does not lend itself to the disease model espoused in medical schools in which there is an "other" to be fixed, removed or eradicated. It is not a diagnosis to be sleuthed, and a clever intervention to be implemented which will bring about resolution, or a predictable course over a limited time period.
A much more helpful model is found in Public Health where there is an agent acting upon a host within a given environment. In the case of domestic violence, this would usually be a man acting upon a woman and child/ren within a societal environment which reinforces objectification of women and fosters the denial of basic human rights to both women and children.
A few years ago in the Department of Family and Community Medicine at St. Paul Ramsey Medical Center, we had a real but limited sense of the degree to which issues of violence and abuse affect the day to day sense of health and well-being in our patients. As early as 1985,
C. Everett Koop identified domestic violence as a major health issue. But we were without skills to ask about abuse in a way that we knew would be respectful and non-revictimizing. We lacked a knowledge base as cursory as that outlined above, and the confidence that we would be able to respond effectively to the answers elicited by the questions we asked.
We sought information and collaborative relationships with battered women's agencies. We worked closely with our county Public Health Department which had identified family violence as an area of focus. We organized and convened two-day long education conferences. Out of these efforts, a partnership has developed -- a commitment among the St. Paul Domestic Abuse Intervention Project, Ramsey County Public Health, and our department to develop mechanisms of training and improved services for our patient population with regard to violence and abuse.
The Partnership has guided changes in our clinic environment which acknowledge that 1) family violence is common and it has a tremendous impact on health 2) our clinic is a safe and supportive place to talk about this. The specifics of our educational efforts and interventions have come about through a long series of discussions with each other in the partnership, and with people actively working their way free of abuse. Though our work continues to be fraught with obstacles, we are confident that collaborative solutions lie ahead in a growing shared reality in which men and women share equal power and respect for each other.
In the opening of her landmark book, Trauma and Recovery, Harvard Psychiatrist Judith Herman discusses the ebbs and flow of study and understanding of the phenomena of psychological trauma. She recounts an 1896 paper by Freud which remains unsurpassed in its clinical description of the effects of childhood sexual abuse. However, there was not a broader social context in which the vast social implications of such a paper could be accepted. By the early 20th century, without any supportive documentation, he repudiated his findings. Then Psychoanalysis, the delving into sexual fantasies of childhood, " the dominant psychological theory of this century was founded in the denial of women's reality."3
Herman states:
To hold traumatic reality in consciousness requires a social context that affirms and protects the victim and that joins the victim and witness in a common alliance. For the individual victim, this social context is created by relationships with friends, lovers, and family. For the larger society, the social context is created by political movements that give voice to the disempowered. 4
At the planetary level, in the mid 1980's IPPNW was able to convey the traumatic realities of nuclear holocaust, and help empower a collective voice which spoke to the unaccept-ability of nuclear weapons and helped to lessen the likelihood of sudden earth catastrophe. The battered women's movement, as a leading voice in a resurgent global peace movement, acts to shape the social context such that lives at risk can be saved and healing bodies and spirits can join together in naming the unacceptability of violent behavior. To the extent that they remain unaddressed, the dynamics of power and oppression continue to flourish in our homes and relationships as well as across continents. Ultimately, they, too, drive us along a pathway to an untenable future. We must build a matrix of healing within ourselves and our families, and work outward toward community, bioregions and the living earth. The pathway to peace is within each of us. The pathway to societal peace with justice is in each of us joining together.
A Short list of collaborative efforts in the Twin Cities:
1. Contact for Partners in Healing Partnership: St. Paul Domestic Abuse Invervention Project, Shelley Johnson, executive director, 612 645-2824; Ramsey County Public Health, Kendra Froland, RN MPH, Family Violence Specialist, 612 266-2409; St. Paul Ramsey Department of Family and Community Medicine, Michael Cline, MD, 612 221-8773.
2. The Minnesota Coalition for Battered Women; coordinating body for agencies of the battered women's movement in Minnesota. Contact Julie Tilley, communications director, 612-646-6177.
3. The Initiative for Violence-Free Families and Communities in Ramsey County; facilitated by local county government, this is a long-term collective commitment on the part of more than 300 citizens and 100 organizations comprising action teams in the workplace, education, neighborhoods, churches, media, gun violence, legislation, cross-cultural approaches, and existing intervention services. Contact Don Gaunt, 612-266-2404.
4. Harriet Tubman Woman's Shelter&emdash;Minneapolis' only shelter within the city limits, Tubman has embarked on a shift away from the well-founded convention of shelter as hidden-away emergency sanctuary to construct a bold new building with state of the art security. The new building will serve the same number of women and children in crisis, an equal number for a 2-3 month transitional period (toward self-sufficiency), and serve as a community education and resource center around issues of violence. Contact: Beverly Dusso, Ex. Director, (612) 827-6105.
5. Metro State University Academic Minor in Community Violence Prevention; thought to be the country's first such effort, a task force of community and faculty are creating curriculum to begin in fall 1994, to bring significant vehicles of training and community networking to Metro's programs of Law Enforcement, Nursing and Social Work as well as to interested students in other disciplines. Contact: Sharon Rice Vaughn, (612) 772-7657
6. Womankind, the nation's first hospital-based women's advocacy program, founded in Edina, Minnesota, 1986; pioneered many of the avenues of existing interface between in-patient Medicine and the resources of the Battered Women's movement. Contact: Susan Hadley (612) 924-5775.
7. Brotherpeace, founded in 1985, an organization of "men breaking silence to end men's violence." Contact Doug Erickson (612) 929-5713.
In the Grand Traverse Bay Region, Women's Resource Center is the leading agency of the battered women's movement. Contact Mary Lee Lord, Ex. Dir., (616) 941-1210.
1. Kempe CH, et al: The battered child syndrome, JAMA,181:17, 1962.
2. McKegney, Catherine: Medical Education: A Neglectful and Abusive Family System, Fam Med, Vol 21, p452 and following, 1989.
3. Herman, Judith: Trauma and Recovery, the aftermath of violence, from domestic abuse to political terror, Basic Books/HarperCollins, 1992, p14;
4. Ibid p9
Michael Cline is a native of Traverse City and a physician in the department of Family and Community Medicine at St. Paul Ramsey Medical Center, St. Paul, MN, (612) 221-8773. He serves on the steering committee of Minnesota Physicians for Social Responsibility.
Return to the Index of Synapse 40, Summer 1997