The Many Faces of Family Violence - Sample Content


"...Anyone who lives in a violent home experiences an essential loss.  The one place on earth where they should feel safe and secure has become a place of danger.  The shadow of domestic violence has fallen across their lives and they are forever changed."
- U.S. Attorney General's Task Force Report on Family Violence, September 1984

Family violence is the most significant public health problem of our time, intimately affecting at least one third of our population and touching many more.  Though alarming reports of deaths that directly result from family violence reach us through the news media, the less sensational secondary effects are equally or more important.  Among women, a large proportion of rapes, drug and alcohol abuse, suicides, and depression can be clearly attributed to domestic violence.   Half of all child abuse, with it's secondary effects of damage to self-esteem, learning abilities, and the ability to form trusting relationships with others is due to domestic violence.  The elderly may be battered, neglected and abused as they decline in health and independence.

Though it is widespread, family violence lies unseen before us, as though the bruises, broken spirits, and cries in the night come from nowhere, inflicted by an invisible hand.  It is most often a deeply hidden secret for those who live within its grasp.  Disguised by lies and excuses, abuse may be denied by its perpetrators and victims even as they lose the last shred of secure reality in their lives.  Because we all know someone who is affected, because we all treat both the victims and perpetrators of these intimate crimes, because we all bear the enormous burden of its social and economic costs, we are all drawn into the scope of family violence.  Our patients, who are caught in the complex allegiances of abusive relationships, hope for more from us, and as health care providers we should be equipped to provide appropriate care.  Choosing to sit on the sidelines of this conflict only encourages the aggressors and further entraps the victims.

This program is intended to equip health care providers with the tools to understand and manage family violence.  Each provider's role may be different and no single individual can be expected to assume the responsibility for changing another's life.  Yet, the act of recognizing the often subtle evidence that family violence is occurring in the lives of our patients and taking the first simple steps that may help them move toward a violence-free existence are part of our essential obligation to them.  To do less, is to treat the symptoms instead of the disease, and to act randomly rather than setting comprehensive and coherent goals for medical care.   These are the principles that have guided the writing of this program:

  Because it is often difficult to take those first steps, it will help to know the steps that follow.

  Because just knowing the prevalence of the problem may not help us to recognize it in our  own patients, many examples will be presented.

  Because myths and poorly-informed opinions present barriers to recognition, common  misconceptions will be dispelled.

  Because knowing that a question must be asked is not the same as knowing how to ask it, the  critical questions will be explicitly spelled out.

  Because knowing that something must be done is not the same as knowing what to do,  discussions of safety planning, follow-up, and referral for therapy are part of this program.

  Because family violence affects the very young, adolescents, adults, and elders, each will  receive consideration in this program.

  Because the recognition and management of batterers is as much a part of the solution as it is  a part of the problem, an approach to the batterer will be discussed.

   To facilitate access to further reading and state agencies, sources of further information and an  extensive list of state and regional resources with addresses and phone numbers is part of the program.

Finally, because statistics, theories, and discussion lead us toward intellectualization and perhaps diminish our empathy for those who live daily with the fear of violence; the words, voices and images of the victims of family violence are presented in this program.

Copyright 1998 David Lickerman, MD