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EMOTIONAL DISTRESS AS ADDITIONAL SUFFERING IN ABUSED WOMEN
• By Ilze Slabbert
• Department of Social Work, University of Stellenbosch
INTRODUCTION
• Research and specialised practice indicate that women who are abused by their intimate partners are at an increasing risk the longer the abuse continues.
• Many men show escalating violent behaviour toward their female partners and many women are killed by their partners.
(Roche, 1999:24)
• Several researchers view domestic violence as a leading cause of female injury in almost every country.
• It is claimed that fatal injuries as a result of domestic violence are more common than from muggings, car accidents and death resulting from cancer combined.
(Artz, 1999:2; Damon, 2003:94; Dwyer, Smokowski, Bricout and Wodarski (1995:185) Flinck, Paavilainen & Asredt-Kurki, 2005:383; Gelles, 1999:168; Vincent & Jouriles, 2002:7)
• Violence against women mostly occur in the home, which is supposed to be a safe shelter for women and children.
• It is no cause for wonder that some researchers claim that the home can be one of society’s most dangerous places when violence occurs in intimate relationships.
(Danis and Lee, 2003:237, Stephens and McDonald, 2002:81; Sullivan and Hagen, 2005:346)
EMOTIONAL DISTRESS
• Intimate partner abuse is increasingly viewed as a prevalent social problem and a source of emotional distress.
• Some authors claim that up to 50% of women worldwide have been abused by their intimate male partners.
• Although women can be violent towards men and abuse also occurs in same-sex relationships, more than 90% of domestic abuse is committed by men against women.
(Buchbinder and Goldblatt, 2011; Carlson, McNutt, Choy and Rose, 2002:720; Parenzee and Smythe, 2003: 33; Prinsloo, 2007:36; Women in Action, 2010)
• Several authors conclude that domestic violence poses a serious threat to public health and the emotional stability of women.
• Some scholars claim that abused women are not wives or girlfriends, but prisoners.
• Implications for emotional health arising from domestic abuse are severe and often life long.
(Eby, 2004; Ferrato, 2002; Georgiadess, 2003; Romito, 2008 Scott-Tilley, Tilton and Sandel, 2010)
• Health care workers often have to do crisis management in domestic violence cases in order to keep the woman and her children safe.
• The emotional distress however, still remains after the safety crisis has been resolved.
• It is vital that health care workers also deal with the emotional distress in order to promote the general well- being of the abused woman and her family.
(Bornovalova et al., 2013; Tilton and Sandel, 2012)
RESEARCH DESIGN AND METHOD • The goal of the study was to gain a clear
understanding of the emotional distress experienced by abused women.
• A qualitative study with a phenomenological approach was proposed.
• The exploratory research design was used to explore the emotional needs of abused women.
• A descriptive research design was also utilised in combination to provide a description of the emotional needs of abused women.
(Fouché & Schurink, cited in De Vos, 2011:316; Whittaker, 2009:34)
• Two non-governmental organisations (NGOs) and one psychologist were approached to obtain the sample of 20 participants who took part in the study.
• Purposive sampling were used as the sample were chosen according to certain criteria.
• Snowball sampling was also used where four participants were referred by other participants.
(Whittaker, 2009:34)
CRITERIA FOR INCLUSION
• They had to be female, between the ages of 22 and 60.
• They had to be in an abusive relationship at the time of the study, or had to have been in an abusive relationship fewer than six months previously.
• They had to be residing in or around Cape Town. • They had to have received professional help from
a social worker, psychologist or nursing sister during the preceding six months, or still be receiving such help.
Profile of participants • The age of the sample of twenty women
varied between 23 and 49.
• Women of all ages and circumstances are exposed to intimate partner violence, not only those who still have children in the home.
• It is however significant that nineteen (95%) of the participants still had to care for dependent children in their homes.
(Danis and Lee, 2003:28)
• Nine of the twenty participants (45%) were married.
• Five of the participants (25%) were cohabiting.
• Six of the participants (30%) were separated from their partners at the time the interviews were conducted. The decision to leave their partners was not easy as all of them faced huge financial challenges.
• The educational level of the participants was also noted.
• It is significant that none of the participants had post-matric education.
• Only four participants (20%) completed Grade 12.
• Six participants (30%) had an educational level of Grade 9 or 10.
• Two of the participants (10%) had completed Grade 8.
• Six participants (30%) had a primary school education varying from Grade 4 to Grade 7.
• Two participants (10%) were illiterate.
SIX THEMES
1. TRAUMATIC CHILDHOOD
2. CONTINUOUS FAMILY DISHARMONY
3. DEPRESSION
4. POST-TRAUMATIC STRESS DISORDER
5. SUICIDAL FEELINGS
6. ATTEMPTED SUICIDE
TRAUMATIC CHILDHOOD
• A significant number of women who report adult partner abuse also often have histories of childhood physical, sexual, and/or emotional abuse.
• Childhood abuse, has been found to have wide-ranging consequences, including post-traumatic stress disorder, anxiety, depression, cognitive distortions, interpersonal problems and low self-esteem.
(Bornovalova et al., 2012; Carlson, McNutt, Choi, and Rose, 2002:724; Flinck et al., 2005 )
• Self-destructive behaviours such as suicide attempts and substance abuse, anger, and revictimization might also be some of the consequences.
• Most of the participants (75%) in this study indicated that they had a difficult childhood.
• At least 11 participants (55%) indicated that they were abused or maltreated as children as illustrated by the following accounts:
• “My mom and dad were separated. My mom was not so nice with me. She always swore and called me names... still today.” Amy
• “My mom dumped me when I was two. I was also tied up by my step dad and raped. I have been beaten with his fists.... I was sent to a Reformatory. I was 16 when I had my first child. It was my step-dad’s child. The baby was given up for adoption.” Rosy
• “I was an illegitimate child. I always felt that no one cared about me. I was molested when I was 10 years old. I had a ‘wonderful’ mom who ignored everything.” Tina
CONTINUOUS FAMILY DISHARMONY • Continuous family disharmony often happens
because of controlling behaviours displayed by abusive men.
• Pressure tactics such as guilt tripping, threats to withhold money and manipulating children all contribute to family disharmony.
(Groves, Kagee, Maman, Moodley and Rouse, 2012; Levendosky and Graham-Berman, 2001:171)
• Some men might also use isolation and prevent their partners from seeing friends in order to control them.
• These men might also harass women by constantly checking up on them.
• The misuse of drugs and alcohol also inevitably leads to family disharmony.
(Ferrato, 2000:7; Mullender and Hague,2005:1321)
• At least 16 of the participants (80%) indicated that they experienced family disharmony whilst in the abusive relationship as gathered from the excerpts below.
• Family disharmony varied from tension because of unfaithfulness (“He has several girlfriends.” Olive),
• behavioural problems with children (“The child of 15 also gives me problems. He is now on TIK” Florry),
• to children witnessing the abuse (“And he always fights in front of our daughter. She is still young.” Beth)
• Some children will typically stand up for their abused mother, as confirmed in Kay’s statement (“She would help me by hitting him back”).
• Several authors observe that family disharmony usually contributes to emotional distress of abused women.
Carlson, 1997:291; Flinck et al. 2005:387; Groves, Kagee, Maman, Moodley and Rouse, 2012; Levendosky and Graham-Berman 2001:171; and Mullender and Hague, 2005:1321)
DEPRESSION
• Depression is the one of the inevitable consequences of emotional distress.
• A significant number of abused women suffer from depression, which is often ignored or misdiagnosed.
• Research indicates an association between partner violence and women’s depression.
• All 20 participants (100%) indicated that in some or other stage in their abusive relationship they experienced feelings of depression, as can be seen from the excerpts.
(Lourens and Kruger, 2013: 248; Pineless, Mineka and Zinbarg, 2008:170; Wiehe, 1998:91).
• Depression varied from feelings of depression (“I get very depressed.” Olive),
• taking medication (“I take medication. I cannot cope without my medicine.” Tina),
• to psychiatric treatment (“I was booked into a clinic where I received psychiatric treatment.” Sally).
• Three participants (15%) had received psychiatric treatment while in the abusive relationship.
• These findings are supported by literature. (Buchbinder and Goldblatt, 2011: 851-873; Callaghan, 1995:12; Leiner, Compton, Houry and Kaslow, 2008: 473-481)
POST-TRAUMATIC STRESS DISORDER
• Research showed that battered women reported higher levels of stress than women who did not experience abuse.
• Symptoms like a pounding and racing heartbeat, trembling hands, headaches and sleep problems were common in abused women.
• It is thus clear that domestic violence could contribute to post-traumatic stress disorder.
(Bollen et al., 1999:39; Eby 2004:221; Vetten, 2007)
• Ten participants (50%) indicated that they experienced physical symptoms related to PTSD.
• These symptoms varied from a pounding heart (“My heart already beats so fast...” Ivy), trembling hands (“My hands are sometimes very shaky...” Diane), headaches (“I suffer from bad headaches”. Hope) and sleep problems (“I struggle to sleep.” Beth).
• Research concurs that post-traumatic stress disorder with symptoms such as anxiety, hyper-vigilance, sleep difficulties, problems with concentration, irritability and feelings of detachment are common in abused women.
• It is clear that female victims of intimate partner violence may develop PTSD and its consequences at an alarming rate.
Eby, 2004:221; Scott-Tilley, Tilton and Sandel, 2010:26 and Krause, Kaltman, Goodman and Dutton, 2008:86)
SUICIDAL FEELINGS
• Suicidal thoughts might be more common in abused women than in non-abused women.
• Some women who are in an abusive relationship think of suicide as the only way to escape their situation.
• The fact that domestic violence is often still seen as a private matter enhances the “trapped” feeling of some abused women.
(Bollen et al., 1999:39; Joyner, Theunisen, De Villiers, Suliman, Hardcastel and Seedat, 2007:15)
• “I am stressed out. At times I want to kill myself. At one stage things were too much for me. I felt that life was not worth living for.” Meg
• “Sometimes I do not want to live any more.” Amy
• “I do not feel good about myself, because he always belittles me. I don’t like this life.” Cathy
• “I burst into tears... I cannot take it any longer... sometimes I wish I was dead.” Olive
• Although it was not directly explored 13 (65%) of the participants indicated that they had entertained thoughts of wanting to end their lives.
• Meg’s statement sums up the general feeling experienced by the 13 participants:
• “I am stressed out. At times I want to kill myself. At one stage things were too much for me. I felt that life was not worth living for.”
ATTEMPTED
SUICIDE • At least three (15%) of the 20 participants
indicated that they had attempted suicide to escape from their situation, as can be seen from the excerpts.
• These attempts varied from cutting wrists (“I have already cut my wrists.” Rosy) to an overdose of pills (“I have already taken an overdose of pills.” Beth; “I wanted to kill myself already because of the entire struggle. I have taken an overdose of pills…Twice.” Cathy).
• Suicide attempts are often more likely to be reported in women who are abused by their intimate partners than women who are not abused.
• It is estimated that battered women are five times more likely to attempt suicide than non-battered women.
• One study noted that a quarter of their abused participants had attempted suicide.
(Bollen et al., 1999:39; Callaghan,1995:12; Vincent and Jouriles, 2002:86)
CONCLUSIONS
• All the participants in the study had experienced some form of emotional distress.
• The emotional distress varied, from the consequences of a traumatic childhood, continuous family disharmony, depression, post-traumatic stress disorder symptoms, suicidal feelings and attempted suicide.
• The nature and scope of domestic violence should not be underestimated by the Health Care profession.
• The impact of the life-long consequences of a traumatic childhood, especially if the abuse cycle continues into adulthood needs to be holistically addressed by different service providers.
• On-going family disharmony often occurs as abusive men attempt to control their female partners, and this could be addressed through family counselling and other interventions.
• Depression as a sign of emotional distress in abused women should be dealt with in a multi- disciplinary approach where health care workers could play a meaningful role.
• Post-traumatic stress disorder is often an on-going occurrence in abused women’s lives as a result of the violence.
• Health care workers should all have adequate knowledge of and insight into post-traumatic stress disorder and crisis intervention.
• Care of abused women who also present with thoughts of suicide and attempted suicide, should receive a high priority and a relevant intervention plan should be compiled to address this.
• Emotional support should be given to abused women by means of counselling or support groups.
• A holistic approach to domestic violence would enable health care workers to address the different needs of abused women and their families.
• A multi-disciplinary team approach including social workers, nursing sisters, doctors psychologists and psychiatrists would be meaningful in rendering services to abused women also addressing their emotional needs.
