chapter 10
INTIMATE PARTNER VIOLENCE ISSUES AND ATTITUDES

Recent adoption and use of the term "intimate partner violence," instead of "wife battering," "spouse abuse," or "domestic violence," is one sign of changing views about violent relationships. Intimate partner violence describes a broader range of abusive relationships, including psychological abuse and social isolation, and acknowledges that violence occurs among unmarried and same-sex partners as well as among persons who do not live together. Also, the term is generally used to describe "a continuing pattern of behavior rather than a single violent act," according to a report of the American Medical Association's Council on Scientific Affairs titled AMA Data on Violence between Intimates (http://www.ama-assn.org/ama/pub/category/13577.html, December 2000 [accessed January 31, 2005]).

The Centers for Disease Control and Prevention (CDC) recognizes that use of consistent terminology is vital for researchers collecting data about the scope of the problem. The centers made a move to establish tracking systems, identify high-risk populations, and assess the results of prevention programs with the publication of Intimate Partner Violence Surveillance: Uniform Definitions and Recommended Data Elements by Linda E. Saltzman, Janet L. Fanslow, Pamela M. McMahon, and Gene A. Shelley (Atlanta, GA: The Centers for Disease Control and Prevention, 2002). The report attempted to standardize terminology in order to enable researchers, health care professionals, and policy makers to use the same terms to describe comparable violent acts.

VIOLENCE ON OUR MINDS

Americans are worried about violence and violent crimes. Surveys find that violent crime, violence in schools and among young people, and the depiction of violence in the media are all causes for concern.

A 2003 poll by the Center for the Advancement of Women found that 92% of women polled listed "reducing domestic violence and sexual assault" as a top priority for the women's movement ("Progress and Perils: New Agenda for Women," June 2003). An October 1998 Harris Poll found that 6% of respondents said they thought it was very likely they would be hit by a spouse or partner, an additional 8% felt it was somewhat likely, and 1% admitted that it had already happened to them. In view of the stigma associated with intimate partner violence and the reluctance to admit or disclose it, the finding that 15% of survey respondents thought it likely to occur or had occurred in their personal relationships was significant.

A poll by Harris Interactive published in the Sourcebook of Criminal Justice Statistics 2002 (Washington, DC: Bureau of Justice Statistics, 2003) compared survey responses given in 1994, 1999, and 2001 to questions about the factors Americans believe contribute to violence in U.S. society. Although the most frequently named causes remained constant through each survey year—in 2001, 86% cited "lack of adult supervision" and 60% said "easy availability of handguns"—the percentage of respondents attributing violence to these factors declined from 1994 to 2001. The biggest drop was in the proportion of persons blaming television news media for encouraging violence—from 39% in 1999 to 30% in 2001.

Men and Women View Domestic Violence Differently

A 1997 survey commissioned by Women's Work, a program of Liz Claiborne, Inc., and conducted by the public opinion research firm Roper Starch Worldwide, found that men and women define domestic violence and abusive behavior differently. Interviews with a random sample of 1,011 adults nationwide revealed that while men and women basically agree that acts and threats of physical violence are abusive, they disagree about the behaviors that constitute psychological abuse.

Controlling behaviors, such as dictating the clothes a woman must wear, was considered abusive by more than

FIGURE 10.1

half the female respondents, but only 33% of men said it was definitely abusive behavior. Less than one-quarter of males thought that withholding money from a wife or girlfriend was abusive, while 37% of women felt it was definitely abusive and 74% thought it probably was.

A greater proportion of women (78%) than men (67%) viewed enforced social isolation—preventing a woman from contact with family and friends—as abusive. Fully 85% of women and 75% of men thought that a man's cursing or insulting his partner in front of others constituted abuse.

About three-quarters of all survey respondents considered violence directed at women by their partners as among the major problems facing the country, and 21% thought it was a minor problem. Two percent said it was not a problem at all. More women (85%) felt domestic violence was a major problem than men (69%).

More than half of all respondents reported that they knew someone directly involved in intimate partner violence, as either a victim or perpetrator. Slightly more women (59%) than men (54%) said they knew someone involved in an abusive relationship. Nearly one-third of respondents knew that about one out of four women is affected by domestic violence, but 37% admitted that they did not know enough about the problem to estimate how frequently it occurs.

FIGURE 10.2

The State of Florida Weighs in on Domestic Violence

In June 1999 the Florida Department of Corrections surveyed state residents about how they felt about domestic violence. Survey respondents were representative of the Florida population and ranged in age from eighteen to eighty-nine years—the average age of respondents was 45.5 years. The survey was composed of approximately 40% men and 60% women.

More than nine out of ten Floridians thought domestic violence is a widespread problem in society, and a large majority (78.6%) felt that their state had seen an increase in the number of incidents of domestic violence during the past decade. Only 6% felt the number of incidents of domestic violence had dropped. (See Figure 10.1 and Figure 10.2.) Official statistics from the Florida Department of Law Enforcement supported public perceptions—reported domestic violence crime had increased by 9%—

TABLE 10.1

and the Florida Task Force on Domestic and Sexual Violence confirmed that only about one-seventh of all domestic assaults are reported to police.

On average, survey respondents said they believed that nearly 40% of men have physically abused an intimate partner at some point in their lives. (See Table 10.1.) Female respondents (42.5%) were more likely than male respondents (32.9%) to believe that men abused their intimate partners.

More than half the respondents (55.5%) knew at least one victim of domestic violence. Nearly 43% of those respondents said the victim was a friend and more than one-quarter said an immediate family member had been a victim of domestic violence. More than one in three respondents (43.7%) reported that they had actually witnessed a man physically abusing his wife or girlfriend. (See Figure 10.3.)

The survey respondents were asked what they believed caused domestic violence. The most frequently cited causes were women's reluctance to leave their abusers (89.8%), partners' inability to communicate and resolve differences (79.4%), drug and alcohol problems (78.4%), and the economic reality that many women are forced to choose between poverty and remaining with their abusers (76.7%). Respondents also thought that many men learned violent behavior in their homes during childhood and adolescence (73.1%), and they believed that the breakdown of the traditional family unit contributed to violence (67.6%).

Almost 65% of those surveyed said the courts did little to protect battered women, and 21.9% said they felt domestic violence exists because police didn't do enough

FIGURE 10.3

to stop it. (See Table 10.2.) More than eight out of ten respondents wanted police to arrest persons suspected of partner violence, and more than 85% want to see offenders who caused serious bodily harm to their victims imprisoned. (See Table 10.3.) More than three-quarters believed that abusers should be both punished and forced to receive treatment; less than 8% felt that punishment without treatment was sufficient.

To compare how survey participants viewed domestic violence in comparison to violence in the community, researchers asked respondents how a man who had beaten up his wife at home should be punished and how a man who had beaten up another man in a bar should be punished. Overall, the respondents did not believe these violent acts should be punished differently. Almost 70% favored imprisoning a man who assaulted a woman at home, and 74% would jail a man who assaulted another man in a bar.

Most respondents said that not enough taxpayer money was being spent on preventing and treating intimate partner violence and enforcing laws against it. Eight out of ten of the respondents would support a tax increase to pay for more counseling for victims. Nearly three-quarters would agree to a tax increase to fund more shelters for victims, and more than two-thirds of respondents were willing to spend more tax dollars to treat offenders.

TABLE 10.2

The respondents believed the most effective strategies for reducing domestic violence were counseling for victims, public education, treatment for abusers, and placing restraining orders on convicted offenders. More female respondents (73.9%) than males (51.8%) thought treatment of abusers would be very effective. Similarly, 80.8% of women favored counseling for victims, compared to 58.8% of men.

When they were questioned about their willingness to help victims of intimate partner violence, nine out of ten respondents said they would call the police if they heard an assault occurring next door. Nearly all the woman surveyed (94.5%) said they would telephone police and 87.9% of men indicated they would contact police. Furthermore, the overwhelming majority (93%) said they would testify in court about an assault they had seen.

Survey respondents were asked whether they agreed or disagreed with the 1997 legislation that made it illegal for a person convicted of domestic violence to own a firearm. Most respondents (89%) agreed with the law, with women expressing more support than men (92.9% and 79.4%, respectively). Furthermore, nine out of ten respondents said neither law enforcement officers nor military personnel should be exempt from the legislation prohibiting convicts or subjects of an injunction from possessing a firearm.

Only 40% of respondents were aware of batterer intervention programs and less than 8% said they knew of

TABLE 10.3

a man involved in one of the programs. Nonetheless, a full 91.8% of those surveyed felt that it should be mandatory for all men charged with domestic violence to attend batterer intervention programs.

The majority of survey respondents thought more public attention would help victims of domestic violence. Figure 10.4 shows that 56.7% of the respondents believed the media had not directed enough attention to domestic violence issues.

How Do Women Feel about Mandatory Reporting of Domestic Violence?

There is considerable controversy about mandatory reporting requirements among health care professionals, patients, and advocates for domestic violence prevention. From 1991 to 1994 California, Colorado, Rhode Island, and Kentucky passed laws requiring health professionals to report cases of intimate partner violence to the police. Proponents of mandatory reporting claim it increases identification and prosecution of abusers and improves data collection. Critics feel it compromises victims' autonomy, may increase the risk of further violence by perpetrators, and endangers patient-practitioner trust and confidentiality.

FIGURE 10.4

Michael Rodriguez et al., in "Mandatory Reporting of Domestic Violence Injuries to the Police: What Do Emergency Department Patients Think?" (Journal of the American Medical Association, vol. 286, no. 5, August 1, 2001), examine how female patients seen in emergency departments viewed mandatory reporting of domestic violence injuries to police. The investigators surveyed 1,218 female patients in twelve hospital emergency departments in California, where reporting is mandatory, and Pennsylvania, where there is no law requiring reporting of domestic violence cases. Twelve percent of the patients (140 women) reported physical or sexual abuse within the year preceding the study by a current or former intimate partner.

To determine patients' views about the mandatory reporting law, female nurses asked the patients, "Do you think the emergency department staff in hospitals should be required to call the police when they think that a husband, boyfriend, or partner (ex-husband, ex-boyfriend, ex-partner) has hurt or abused an adult patient?" Respondents could choose one of three answers: yes, every time; every time unless the patient objects; and never.

Rodriguez et al. found that more than half (55.7%) of the recently victimized female respondents supported mandatory reporting of intimate partner violence to police, while 36.4% thought physicians should report only with patient consent. About 44% of abused women opposed mandatory reporting. The women who opposed mandatory reporting tended to be younger and nonwhite.

Of the women with no prior history of abuse, 70.7% favored mandatory reporting and 29.3% opposed it. Women who were primarily non-English speaking were more likely to oppose mandatory reporting, perhaps because their experiences with police were different from the experiences of U.S.-born women or because they feared deportation.

There were no differences between the opinions expressed by women in California and those in Pennsylvania. Similarly, opposition to reporting did not vary by relationship status or income.

Rodriguez et al. conceded that one of the limitations of their study was that it very likely did not obtain the opinions of women who failed to seek care in California because they knew of the mandatory reporting requirement and did not wish to have their perpetrators identified. If abused women were choosing not to seek emergency department care because of reporting requirements, then this study may have underestimated the extent to which abused women would oppose laws that mandate reports to police.

THE AMERICAN PSYCHOLOGICAL ASSOCIATION CONSIDERS THE ISSUES

The Report of the American Psychological Association Presidential Task Force on Violence and the Family (Washington, DC: American Psychological Association, 1996) revealed some of the issues that challenge researchers and professionals seeking to prevent and stop domestic violence. The Task Force identified twelve dilemmas faced by family violence researchers and mental health practitioners, including these concerns:

• Privacy—There is an inescapable tension between the right of individuals to privacy and the need to penetrate the isolation and secrecy that often shield intimate partner violence from public scrutiny. One example of how this concern affects research is the preponderance of data suggesting that more violence occurs among low-income families. Researchers speculate that these data may simply indicate that low-income victims who must rely on hospital emergency departments and battered women's shelters are less able to conceal the consequences of abuse than persons with greater resources.
• Expectations of law enforcement—There are differing expectations of the police response to violence. Many victims want the police to intervene to stop abusive behavior, but they do not want the perpetrators punished. On the other hand, researchers, health professionals, and law enforcement personnel often contend that mandatory treatment and arrests are necessary to protect victims from further harm and to safeguard the community at large.
• Conflicting attitudes about abuse—Although most people feel sympathy for victims, there are those who believe that society inadvertently encourages victims by allowing them to use a history of abuse as an excuse for all subsequent bad behavior and problems. This viewpoint is different from blaming the victim for the abuse because it is intended to help victims assume individual responsibility for their behavior, and to heal and recover, rather than remain in the role of victim.
• Effectiveness of mandated treatment—There are ongoing debates about the effectiveness of different philosophies and models of treatment, as well as the use of court-ordered treatment. While some abusers who complete mandatory treatment programs do change their behavior, many studies confirm that these perpetrators are the most motivated and that many other offenders fail to complete court-ordered treatment. However, the American Psychological Association asserted that while the desire to change is linked to favorable outcomes of treatment, involuntary treatment can nevertheless be effective, especially when the perpetrator has been evaluated and enrolled in the most appropriate program.

PREVENTING RELATIONSHIP VIOLENCE

In 2000 the Working Group on Intimate Partner Abuse and Relationship Violence, a multidisciplinary group with members from five professional societies, published a curriculum for psychologists addressing issues related to researching, preventing, and treating intimate partner violence. The objectives of prevention were described as:

• stopping the violent behavior from ever occurring
• delaying the onset of violent behavior
• reducing the impact of existing violent behavior
• strengthening behaviors that promote emotional and physical well-being, thereby inoculating people from the negative effects of relationship violence
• supporting institutional, community, and government policies that promote the prevention of relational violence

The American Psychological Association recommends instituting violence prevention programs aimed at middle school, high school, and college students that are intended to heighten awareness and reduce rates of date rape. Furthermore, it is important that the prevention programs be repeated since there is considerable evidence that these education programs do produce measurable effects on knowledge and attitudes, though the effects are often not lasting.

Other special-needs populations that the curriculum targeted for prevention programs include immigrants, ethnic minorities, and persons who are gay, lesbian, or bisexual.

Levels of Violence Prevention

Many researchers believe that in order to effectively address the public health problem of intimate partner violence, health professionals, policy makers, educators, and women's advocates must intensify violence prevention efforts. There are three levels of prevention.

Primary prevention of intimate partner violence aims to reduce harmful circumstances before they can produce violence and includes global educational efforts to promote nonviolent interactions and relationships.

Secondary prevention of intimate partner violence is intended to break the pattern of violent behavior before it becomes deeply ingrained. Examples of such efforts are early identification and counseling of first-time offenders to challenge and change behavior as soon as possible after its occurrence. Unfortunately, few programs specifically targeting first-time offenders are available, and programs for chronic perpetrators often alienate first-time offenders who feel they do not belong with severe batterers.

Tertiary prevention of intimate partner violence involves services for victims, counseling, and mandatory treatment of offenders, and may also involve justice interventions including arrest and incarceration.

Primary Prevention Theories

The majority of efforts to date focus on tertiary prevention. However, changing attitudes about intimate partner violence and increasing recognition of violence as a societal problem that affects everyone, not simply the victims, emphasize the need for primary prevention. An example of this effort is the David and Lucile Packard Foundation's support of the "Next Generations: Strengthening Young Families and Communities through Prevention of Child Abuse, Youth Violence, and Domestic Violence" initiative. It aims to contribute "a research and evaluation perspective" to primary prevention efforts, according to Jeffrey L. Edleson, Deborah Daro, and Howard Pinderhughe in "Finding a Common Agenda for Preventing Child Maltreatment, Youth Violence, and Domestic Violence" (Journal of Interpersonal Violence, vol. 19, no. 3, March 2004). The Next Generation initiative is a collaboration with the Family Violence Prevention Fund and the National Funding Collaborative on Violence Prevention.

Neil B. Guterman, in "Advancing Prevention Research on Child Abuse, Youth Violence, and Domestic Violence: Emerging Strategies and Issues," argued that primary prevention programs are still in their infancy (Journal of Interpersonal Violence, vol. 19, no. 3, March 2004). He believes that in order for primary prevention programs to be truly effective, researchers need to do the following:

• formulate a universal definition of family violence to allow comparable measurements of family violence
• design research studies to advance knowledge of how to assess risk for future violence in order to target prevention efforts
• design research studies to advance knowledge on how to intervene in violent relationships to prevent future violence

While the author acknowledges there is often a gap between research into possibly effective prevention strategies and the implementation of those programs, he argued that "these tensions between prevention practice and research… can be viewed as instilling healthy and productive pressures in both directions. For researchers, such pressures mandate that research activities ultimately should be 'in the service of service' …and for practitioners… they mandate that their real world strategies are rigorously grounded, optimally evaluated in an objective fashion."

In Primary Prevention of Intimate Partner Violence (Washington, DC: National Institute of Mental Health, July 2002), researchers Martha Smithey and Murray Straus described the environmental changes and educational approaches they feel will serve to reduce the risk of intimate partner violence for the entire population. Smithey and Straus asserted that "the outcome envisioned as a result of primary prevention is that, although some individuals may continue to be violent, their number will be reduced."

Smithey and Straus feel primary prevention is consistent with the feminist approach to reducing intimate partner violence, since feminists view patriarchy and male dominance as the principle causes of violence. Feminists view societal change that promotes equality between men and women as primary prevention of partner violence. Underlying this view is the belief that the more humane a society becomes, the less likely that its individual members will resort to intimate partner violence.

Smithey and Straus found that while there are few programs specifically aimed at primary prevention of intimate partner violence, some programs offer both primary and secondary types of services. For example, in addition to aiding victims, battered women's shelters may offer community education and other programs to empower women. Furthermore, the presence of shelters in a community sends a clear message that victims have alternatives to remaining in abusive relationships and conveys the community's intolerance of partner violence.

Similarly, the justice concepts of "general deterrence" and "specific deterrence" have primary and secondary prevention objectives. Legal sanctions, such as arrest, prosecution, mandatory treatment, and incarceration, deliver the secondary prevention benefit of deterring an offender from further violence and may also perform a primary prevention function: deterring others from perpetrating violence by warning them of the consequences of their actions. Although there are no data linking legislative changes, such as the enactment of the 1994 Violence against Women Act and the criminalization of wife beating, to changing public attitudes about intimate partner violence, Smithey and Straus argued that the combination of legal reform and widespread access to and availability of services such as hotlines, shelters, and advocacy has resulted in social change.

Smithey and Straus presented eleven criminal justice theories and their implications for primary prevention of intimate partner violence. The following theories have practical applications for prevention programs:

• Deterrence Theory—Intensify formal and informal sanctions for abusive behavior by family, friends, and colleagues.
• Strain Theory—Create more opportunities for education and economic achievement, promote gender equality in the family, and foster realistic expectations of marriage and cohabitation.
• Social Learning Theory—Discourage corporal punishment of children and reduce celebration of violence in the media.
• Control Theory—Strengthen family ties by offering parenting education.
• Moral Justification Theory—Eliminate social approval of violence as a means of supporting moral standards, such as governments' use of capital punishment.
• Control-Balance Theory—Enhance gender equality in the family and reduce social isolation to enable social controls that condemn the use of violence to govern behavior.
• Conflict Theory—Promote economic, social, and political equality and increase access to and availability of marriage counseling.
• Feminist Theories of Criminal Justice—Treat all victims as reliable and truthful and strengthen criminal justice sanctions for intimate partner violence.
• Feminist Theories of Crime/Power-Control Theories—Eliminate male dominance in society and the home.
• Survival Strategy Theory—Increase the availability of escape options, such as shelters and safe houses, for victims of abuse.
• Convergence Theory—Eliminate differences between criminal justice treatment of victims by gender of victims and offenders and reduce cultural support and celebration of violence.

Smithey and Straus also commended the United Nations' leadership role in global primary prevention of partner violence, evidenced by its adoption of the Domestic Violence Resolution in 1985. In its Progress of the World's Women 2000: UNIFEM Biennial Report, UN officials stated that "violence against women and girls constitutes the single most prevalent and universal violation of human rights" (New York: UN Development Fund for Women, 2000).

Despite these promising observations about changing attitudes and reliable data indicating that intimate partner violence is decreasing, Smithey and Straus cautioned that there is no direct evidence demonstrating that declines in violence rates since the mid-1970s have resulted from prevention programs. They offered other factors that may contribute to declining rates of violence, such as an increase of three years in the average age at marriage between 1970 to 2000. Another possible explanation for the decline is that prevention programs have effectively stigmatized partner violence to the degree that there is even greater reluctance, on the part of both victims and perpetrators, to disclose it. Even so, there might be cause for cautious optimism—greater reluctance to admit to abusive behavior indicates that society is less tolerant of violent personal relationships.

Primary Prevention Programs

A number of primary prevention programs are emerging to address the problem of intimate partner violence. Some began during the 1990s and others have been instituted as recently as 2000. Research has not yet evaluated their effectiveness, but researchers and battered women's advocates are hopeful that these initiatives will further reduce public acceptance and tolerance of intimate partner violence. Some examples of primary prevention programs follow.

The National Center for Injury Prevention and Control, an agency of the Centers for Disease Control, developed and implemented the Family and Intimate Violence Prevention Program to focus on surveillance, research, evaluation, and training and to fund community-based prevention programs at all levels of prevention. In addition to supporting community-based projects, such as the Milwaukee Women's Center and Georgia's Men Stopping Violence, Inc., the agency also sponsors projects aimed at preventing intimate partner violence in specific populations, such as rural and Native American communities.

The National Crime Prevention Council offers schoolbased prevention programs that train teens to respond to hotline callers and perform peer counseling. The council focuses on violence in teen dating relationships, and its dating violence intervention projects teach boys and girls not to accept violence in their earliest relationships, even before they begin dating. The students are taught how to identify and resolve conflict, recognize abusive behavior, and communicate respectfully with their peers.

The National Advisory Council on Violence against Women was established in 1995 with the goal of eliminating social norms that support and condone violence against women. To achieve this ambitious goal, the council coordinates multidisciplinary efforts involving community leaders and representatives from health care agencies, the military, organized sports, the social welfare system, the justice system, the media, academia, businesses, and religious communities. The council also supports education of children about gender roles and stereotypes that condone violence against women.

The Family Violence Prevention Fund is a national, nonprofit organization that offers primary, secondary, and tertiary prevention programs. One of their aims is to educate the general public that when people fail to speak out against partner violence, they perpetuate the problem with their silence. To this end, the Fund produced the media campaign "There's No Excuse for Domestic Violence." The fund also provides services for abuse victims, offers community and professional education programs for the public at large, and actively seeks public policy reform. The fund is one of the organizations active in the initiative "Next Generations: Strengthening Young Families and Communities Through Prevention of Child Abuse, Youth Violence, and Domestic Violence."