[DEBATE] : domestic violence

[Russell]

Dr Michael Fitzpatrick
Doctors cannot stop domestic violence
The campaign to get GPs to 'screen' their patients for signs of abuse is 
based on the poisonous idea that violence between partners is widespread.

'Intimate partner violence, which may be physical, sexual or emotional, is a 
major public health problem because of the long-term health consequences for 
women who have experienced it and for their children who witness the overt 
violence and coercion.' (1)
This statement, in a recent editorial in the British Journal of General 
Practice, signals a renewed campaign sponsored by the medical establishment, 
to make the detection of domestic violence - now relabelled 'intimate 
partner violence' - the responsibility of family doctors.
Controversy rages over whether GPs should 'screen' their patients, by 
routinely inquiring whether patients are victims of abuse, or limit such 
inquiries to women who present with mental health problems. But medical 
authorities agree that GPs need more training in the recognition of abuse 
and in the approved techniques for dealing with it - even though, as the 
author of the editorial quoted above admits, there has been no confirmation 
of the 'effectiveness of interventions following screening'.
In addition to receiving exhortations to do more about domestic violence, as 
a GP I am now obliged to undergo special 'child protection' training and am 
also the target of propaganda to raise my awareness of 'elder abuse' and 
other areas of victimhood in which needs remain 'unmet'.
The discussion of domestic violence that has assumed such prominence in 
medical journals suffers from a lack of historical and sociological 
perspective. The concepts of 'abuse' and its presumed consequences of 'low 
self-esteem' and 'post-traumatic stress syndrome' are taken at face value 
instead of being understood as recently constructed categories that provide 
a framework for the reinterpretation of personal experience at a particular 
historical moment.
Over the past decade an obsession with abuse as a pervasive feature of all 
intimate relationships has risen to acquire an extraordinary prominence in 
Western society. It is now widely accepted that diverse forms of 
intimidation and exploitation are commonplace - if not universal - in 
relationships between sexual partners (including same-sex relationships and 
male as well as female victims), between adults and children (child abuse, 
especially sexual abuse, not forgetting 'elder abuse'), even among children 
(bullying, pathological peer pressure). Abusive relationships of all sorts 
provide the themes for a vast outpouring of novels, plays, films, 
documentaries - not to mention court cases and news reports.
Take, for example, the current non-fiction paperback bestsellers in Britain. 
Six of the Top 10 books feature themes of abuse. At number 2, Kathy O'Beirne 
tells her story, 'a true tale of a childhood destroyed by neglect and fear'. 
At number 3, Roberta Taylor's memoir of an East End childhood offers an 
account of 'an embattled family at war with itself and the outside world', a 
story of 'emotional blackmail, illegitimacy, adoption and even murder'. The 
list includes two books by Torey Hayden, whose experience as a 
psychotherapist with abused and traumatised children has provided the raw 
material for a series of tearjerkers. Sharon Osbourne's autobiography tells 
of 'life with a wife-beating, drug-addicted, sex-crazed alcoholic'. After 
this catalogue of degradation, it is almost a relief to find - albeit at 
number 10 - Gloria Hunniford's uplifting tribute to her daughter who died 
from cancer.
Two recent childhood memoirs offer a valuable contrast. Bryan Magee tells 
the story of his upbringing in East London in the 1930s; John McGahern grew 
up in rural Ireland in the 1940s and 1950s (2, 3). Both are finely observed 
and elegantly told stories of childhood and family life. Both are also 
deeply moving accounts of childhood trauma and neglect. Both writers detail 
the pervasive violence of their respective societies and relate their 
experiences of violence in the home, at school and in the wider community. 
Both are also accounts, not of 'survival' - the highest aspiration of the 
contemporary culture of abuse - but of transcendence.
If the violence that characterised family life in the recent past is 
shocking, so too is the level of emotional ill-treatment. The memoirs of TV 
chef Nigel Slater and Beatles biographer Philip Norman emphasise the callous 
neglect of children in middle-class English families in the 1950s, when it 
seems that many parents behaved without regard for the mental states of 
their children (4, 5).
While the worlds described in these memoirs are recognisable, they also seem 
strikingly remote. What is remarkable is the dramatic decline in the scale 
and social acceptability of violence in the home over the course of the 
postwar decades. This trend was accompanied by a growing recognition of the 
emotional needs of children - reflected in controversies about maternal 
deprivation and institutionalisation and the steady retreat from corporal 
punishment in schools and in the home. No doubt the causes of these major 
cultural shifts are complex. In his history of the twentieth century, Eric 
Hobsbawm writes of the social and cultural 'revolutions' that took place 
between 1945 and 1990, characterised by rising living standards, greater 
sexual equality and the decline of patriarchal authority in the family (5).
In short, it appears that the development of more civilised relations 
between the sexes and the generations was the consequence of the wider 
social progress that occurred in the second half of the twentieth century. 
By contrast, over the past decade, not only has social progress apparently 
ceased, but in the prevailing climate of postmodernist cyncisim, the very 
concept has been repudiated. At a time when society has lost faith in the 
possibility of collective solutions to personal and social problems, the 
individual is reduced to the status of victim whose survival depends upon 
professional recognition and support.
The project of medicalising 'intimate partner violence' can best be 
understood as a morbid symptom of the culture of abuse. Far from helping 
vulnerable individuals, it is likely to compound their diminished autonomy 
and reinforce their dependency. The lesson of history is that improving the 
quality of human relationships is a social not a medical project.
Dr Michael Fitzpatrick is author of The Tyranny of Health: Doctors and the 
Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon UK or 
Amazon USA). An edited version of this article appeared in the June issue of 
the British Journal of General Practice.

(1) Feder G. Responding to intimate partner violence: what role for general 
practice? (editorial). British Journal of General Practice 2006; 56: 243-4 
(April)
(2) Magee B. Clouds of Glory: A Hoxton Childhood. London: Jonathan Cape, 
2004
(3) McGahern J. Memoir. London: Faber, 2005
(4) Slater N. Toast: The Story of a Boy's Hunger. London: Harper, 2004
(5) Norman P. Babycham Night: A Boyhood at the End of the Pier. London: Pan, 
2004
(6) Hobsbawm E. Age of Extremes: The Short Twentieth Century.  London: 
Michael Joseph, 1994