[DEBATE] : domestic violence
grinker at mweb.co.za
Sat Jun 17 08:50:40 BST 2006
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
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
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
(2) Magee B. Clouds of Glory: A Hoxton Childhood. London: Jonathan Cape,
(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,
(6) Hobsbawm E. Age of Extremes: The Short Twentieth Century. London:
Michael Joseph, 1994
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