The “Fisted-Hand Syndrome”: Looking at Domestic Violence From a Public Health Lens.

Renán E. Orellana, Co-Editor-in-Chief

“In the nineteenth century, the central moral challenge was slavery. In the twentieth century, it was the battle against totalitarianism. We believe that in this century the paramount moral challenge will be the struggle for gender equality around the world.”
― Nicholas D. Kristof, Half the Sky: Turning Oppression into Opportunity for Women Worldwide

Marianne, the national emblem of France. Columbia, the female personification of the United States of America. Britannia, the female visual representation of Great Britain. These national emblems represent the ideals of personal and social liberty, the foundations for democracy and freedom. Monuments erected in countries throughout the world, including Bulgaria, El Salvador and Latvia, use a female figure inspired by the image of the Roman goddess Libertas, the symbolic embodiment of personal and national liberation.

The irony lies in how this emblematic symbolization of freedom and liberty uses the image of a woman, while throughout the world, women and girls continue to be bound to lives of sexual slavery, abuse, oppression and violence. Billions of women have yet to break free from binding chains of oppression. The idea that a woman is the “universal” icon used to commemorate personal and social liberation disturbs me. It’s incongruity with the realities faced by women around the world becomes a misrepresentation of a gender that continues to face subjugation, exploitation and injustice.

A Portrait of Domestic Violence Around the World
UNiTE, the United Nations Secretary-General’s campaign to end violence against women, spotlighted domestic violence (also known as ‘intimate partner violence’) as “the most common form of violence against women worldwide, without regional exception” 1.

Global trends indicate that “women aged between fifteen and forty-four are more likely to be injured or die as a result of male violence than through cancer, traffic accidents, malaria and war combined”2. A report by the Geneva Center for the Democratic Control of Armed Forces put it into the most gruesome but tangible terms: “violence against women causes every 2 to 4 years a mountain of corpses equal to the Jewish Holocaust” 2.

The billions of cases of domestic violence across the globe manifest themselves differently, with varying degrees of intensity and severity in the oppression, maltreatment and subjugation faced by the victims of abuse. At the end of the day, however, domestic violence in any form is intolerable and should be put to an end.

The Centers for Disease Control and Prevention documented that one in four women (25%) has experienced domestic violence in her lifetime 3. Sadly, open discussion of individual cases of intimate partner violence is rare as it tends to happen in secret due to its confinement primarily to the household setting. Since the woman tends to live with her abusive partner, it is uncommon for others outside the household to be aware of the violent situation she endures. Facing financial and emotional dependence to her abuser, most often a member of her own family, a woman can be bound to a lifetime of abuse without ever finding an escape route from this world of oppression. By compounding stigmatization and the inculpation of victims of domestic violence in certain communities, many women begin to feel as if there is no way out of this hopeless situation.

There are certain places around the world where the penal system does not yet recognize domestic violence as a legitimate legal concern. Consider Russia, where an estimated “14,000 women were killed by their partners or relatives in 1999, yet the country still has no law specifically addressing domestic violence” 3. Furthermore, traditional practices that enable the perpetuation of domestic violence in certain countries have been commonplace for centuries. Thousands of Indian and Pakistani women are “victims of ‘dowry deaths’, killed because their bride-wealth is deemed insufficient by the groom’s family” 3. An estimated 5,000 women are killed every year in ‘honor’ crimes, according to the United Nations Population Fund, and certain countries do not prosecute or punish murders perceived as ‘honour killings’ 3. Consider a study of female deaths in Egypt, where “47 per cent of the women were killed by a relative after the woman had been raped” 3. It is also estimated that ‘honor killings’ take the lives of least three Pakistani women every day 3.

Gender-based violence is the leading cause of injury to women around the world, given that at least one in every three women has been beaten, coerced into sex or otherwise abused during her lifetime 4. In the U.S. and Europe, the concept of domestic violence may not seem to be a pressing issue to address in the overburdened political and legal arenas. But the reality is that when statistics on domestic violence against women indicate that “three to four million women in the United States are beaten in their homes each year by their husbands, ex-husbands, or male lovers,” the issue of gender violence should become a high-priority issue to address in public policy and public health 4. A study showed that “ninety-two percent of women surveyed listed
reducing domestic violence and sexual assault as their top concern” 5. Despite the necessity and public demand for reform in addressing domestic violence, why is the issue not a priority or top concern on the political agenda to the extent that it should be?

James Allen Fox, author of The Will to Kill: Making Sense of Senseless Murder, explains how “social and legal interventions to abuse victims [are] not equally extensive in all parts of the country” 6. This is a recurring issue in public health considering that providing accessibility to services – be it clean water, vaccinations, healthcare, or sanitation – across the general population is always a difficult task, especially when dealing with marginalized and isolated groups. In addition, the “feminization of poverty” contributes to a woman’s economic vulnerability and in turn shapes how vulnerable she is to violence.

The Urban Predicament and “Stockholm Syndrome” Bind                     
In a similar way to many other public health interventions, the availability of interventions for victims of domestic abuse varies according to the urbanness of the location. The general decline in the percentage of femicides involving an intimate is primarily in larger cities where there is a greater emphasis in providing resources for battered women 6. Not only are abuse hotlines, shelters, support groups and counseling services less available in the suburbs and in rural areas, but access to “escape routes” also becomes a problem in these less urban settings. Women may remain in dangerous or potentially lethal relationships “to avoid the stigma within her small community” 6. The psychological effects of abuse can also restrain a woman from leaving an abusive partner. Some women face a phenomenon similar to the “Stockholm Syndrome,” which was used to describe the compliant behavior of wartime hostages toward their captor. Some domestic abuse victims may become “trapped in a violent relationship [and] become more closely bonded to the attacker….[focusing] exclusively on his real or imagined good points” 6. Another phenomenon, labeled by Fox as “learned helplessness,” binds a mother to her abusive partner due to her frustration for “ineffectual struggles to repel early episodes of abuse…[which develops into] a sense of resignation that she is helpless in controlling her fate or that of the children” 6.

An Economic Blow
Domestic violence should be seen as a complex and multidimensional phenomenon that takes into account psychological, biological, socio-cultural and economic factors. The result of violent behaviors intertwines the individual, familial, community and societal dimensions and their consequences take place in diverse contexts and conditions 7. Domestic violence is shown to increase morbidity and mortality rates, and debilitates women, an integral part of the workforce. Billions of women are an untapped economic force that can contribute significantly to a country’s economic growth. Placing human rights issues to the side and considering reform solely for its economic gains and increased yields by the workforce, statistics indicate that “domestic violence victims lose nearly 8 million days of paid work per year in the US alone—the equivalent of 32,000 full-time jobs” 8. Furthermore, consider it as a widespread issue in preventable healthcare spending when “women who have experienced domestic violence are 80 percent more likely to have a stroke, 70 percent more likely to have heart disease, 60 percent more likely to have asthma and 70 percent more likely to drink heavily than women who have not experienced intimate partner violence” 11.

The Cyclical Nature of Domestic Violence
The first step in understanding the perpetuation of a phenomenon should be to understand its roots and origins. Apart from the pervasive systems of inequality around the world, the culture of “male chauvinism,” a traditional sexist outlook, is a prevalent mentality that perpetuates the subordination of women and drives this particular cycle of violence. Around the world, men feel a sense of patriarchal responsibility to have absolute control over family matters 6. Usually having the position of the “breadwinner” within the family unit, any perceived insubordination or threat to a male’s self-entitled absolute control over family matters is frequently met with force or violence. In these circumstances, the abusive husband’s “sense of ego and self-worth depends on his ability to control, dominate and manipulate his wife and children” 6.

Children ultimately become secondary victims and are instrumental in the continuation of domestic abuse across generations. Male children raised in these violent households develop skewed conceptions of manliness and typically inherit their father’s perception of household power dynamics 6. And girls (unless taught otherwise), become victims of this cycle when they are taught by their parents that this is the way a marriage or intimate relationship should function. Studies show that “witnessing violence between one’s parents or caretakers is the strongest risk factor for transmitting violent behavior from one generation to the next” 9. Statistical evidence on the perpetuation of this cycle indicates that “boys who witness domestic violence are twice as likely to abuse their own partners and children when they become adults,” learning that battering and physical aggression are normal and acceptable ways of expressing their frustration and resolving conflicts 10. In order to eradicate domestic violence, this chauvinist culture must be changed, specifically by addressing the possibility of breaking the cycle through social interventions targeting children.

Curing the “Fisted-Hand Syndrome”: FTST prevention efforts
Contemporary methods of dealing with domestic violence merely point fingers, reprimand and criminalize the perpetrators, and offer support and restoration to the victims of a violent ordeal. There should be a reevaluation of public policy and social movements against domestic abuse and a focus on prevention efforts. We cannot simply defer the issue to the legal system any more. Instead of simply placing a band-aid on the issue, we should espouse comprehensive interventions and approaches that seek to end the deeply-rooted cycles of abuse that will continue to perpetuate this unacceptable cultural and societal phenomenon. It becomes a public health problem when domestic violence places a burden on the health and well-being of victims and other members of the community.

The inaccessibility and unequal distribution of services and interventions are two of the most critical issues faced in the field of public health. This is a problem in dealing with domestic violence as social interventions that empower women or provide legal outlets and financial independence are inaccessible in certain communities and nations. Yes, restraining orders, mandatory police arrest procedures and divorce laws have become viable escape routes for some women in most developed countries, but more sustainable interventions should further the involvement of women – 51% of the world’s population – in legislative, financial and community affairs. Though the current state of gender dynamics in the U.S. still requires considerable advancements, the significant progress made during the past few decades should serve as a template in understanding how “improvement in the economic status of women [can] erode the patriarchal control men have historically had over their spouses” (Fox 66).

Several public health campaigns against the AIDS epidemic focus specifically on preventing mother-to-child transmission (MTCT) of HIV. Maybe the eradication of domestic violence should adopt a similar approach – preventing the father-to-son transmission of these twisted gender roles, ending a cycle that justifies the traditional and outdated perspective that a man’s patriarchal duty entitles him to use force to secure his absolute control over a woman.



One comment

  1. Anonymous · ·

    very interesting stuff!

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