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Domestic violence and mental health: How are they intertwined?

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The United States still has a lot of work to do in regard to addressing the prevalence of domestic violence.

In fact, an in-depth story from the Arizona Republic has pointed to the fact that in the last several years, the number of deaths from domestic violence has stayed fairly consistent in Arizona.

While this means there hasn’t really been an increase in deaths, there certainly hasn’t been a decrease either.

Fortunately, researchers are seeking more information about domestic violence and specifically about domestic violence that ends in death. Not surprisingly, much of the research has a mental health aspect.

For example, the article mentioned how substance abuse, depression and estrangement are just some of many risk factors that could increase a battered woman’s chance of eventually being killed by her partner.

Later, the article explained that generally before a battered woman’s life ends at the hands of her partner, there are warning signs. For example, the partner usually engages in a specific kind of abusive behavior called “intimate partner terrorism” or “coercive control.”

“Coercive control is almost exclusively the domain of men,” according to the article. “It is long-term and tyrannical abuse that includes, often in addition to physical violence, attacks on a woman's self-worth, degrading remarks and obsessive monitoring of her whereabouts and her contact with other people.”

The abuser often has mental health issues like depression or substance abuse, and struggles with obsessive and possessive behavior. In some cases, abusers cope with massive self-shame by severely abusing or killing their partners.

Mental health experts have more insight into how domestic violence can impact mental health, and what issues sometimes predispose people to being in relationships that involve domestic violence.

Nerina Garcia-Arcement, a licensed clinical psychology and a clinical assistant professor at the NYU School of Medicine, said in an email that there is a gradual process that leads from “normal” relationships to relationships involving domestic violence.

“Women don't enter violent relationships where they are being hit from day one,” Garcia-Arcement said. “They date men that pay attention to them, are possessive and slowly begin to limit their behavior and social interactions (i.e., the woman can't talk to friends or family as much or at all, or she can't wear certain things). Often this controlling behavior is couched as ‘loving them.’"
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Then comes the act of lowering the victim's self-esteem.

“Once they are socially isolated, they (abusers) begin to erode their self-esteem by insulting them or calling them names, telling them that no one else would want them, etc.,” Garcia-Arcement said. “Once the (victim’s) self esteem is fragile, they often begin the physical abuse.”

“This is why women don't just leave,” she added. “By the time they are being hit, they are socially isolated, feel stupid and undesirable, doubt their self-worth and fear the consequences of leaving. If they are not staying out of fear, they are staying because they have come to believe they deserve this treatment, that they are at fault for being hit, for ‘being stupid/saying the wrong thing,’ etc."

Women in abusive relationships tend to suffer from mental health issues like anxiety, depression and post-traumatic stress disorder as a result, she said.

“Many women who are in abusive relationships grew up in households where they witnessed abuse,” Garcia-Arcement said. “This normalizes it. Confuses love and violence. This is a pattern that is familiar. For other women (who) don't grow up in abusive households, the typical cycle of abuse prepares them. Their self-esteem gets eroded until the abuse makes sense.”

David M. Reiss, a psychiatrist and previous interim medical director for Providence Behavioral Health Hospital, just spoke at the 35th annual convention of the International Psychohistorical Association about child abuse and trauma, and their impact on individuals, communities and society. He said in an email that relationships with domestic violence are characterized by dysfunction and pathology.

“No relationship can maintain appropriate intimacy and trust if there is violence occurring,” Reiss said.

Some women also try to rationalize that it’s better for the children if they stay with their abusive partner.

“Staying ‘for the children’ is misguided, as children need role models who do not let themselves be abused,” Reiss added.

Freda Emmons, the author of “Flame of Healing: A Daily Journey of Healing From Abuse and Trauma,” said in an email that she grew up with abuse throughout her childhood.

Her mother was a victim of abuse by her father, and the mother also contributed to some child abuse along with the father.

“I asked her once why she stayed and she said it was because of us kids; she didn't believe that she could provide for us,” Emmons said. “I told her it would have been better to get assistance or whatever she could do to spare us the horrible years of pain.”

However, Emmons’ mother couldn’t take care of herself and was suffering from issues that are associated with abuse victims, so she was unable to protect her children from their father or herself.

“I think some women have been so battered, physically and emotionally, that they have lost their sense of personal value,” Emmons said. “They think that they are the cause of the problem, that if they would just be a better wife, mother, spouse, cook, cleaner, etc. that the abuse would stop. It never does.”

She hopes her book can help others find a way out of the despair she experienced.