ABC of Domestic and Sexual Violence
ABC of Domestic and Sexual Violence
Susan Bewley 1 and Jan Welch 2,3
1Women's Health Academic Centre, King's College London, UK
2Caldecot Centre, King's College Hospital NHS Foundation Trust, UK
3South Thames Foundation School, UK
Why do health care professionals need to know about domestic and sexual violence? Surely these are either private issues or someone else's business (e.g. the police)? In recent years it has increasingly been recognised that this is not the case. 'Privacy' has allowed serious crime to go undetected and perpetrators to act with impunity. Health care professionals look after patients whose lives are blighted by violence and abuse, whose health is impacted – and who can be helped if the professionals understand how.
Even though domestic and sexual violence affect far more people than do conditions such as diabetes and inflammatory bowel disease, they have featured much less on medical school and postgraduate curricula, and are sometimes entirely absent. Many doctors are not aware of how common these problems are, how to identify them or what to do next. This book aims to provide practical support to learners early in their careers.
Allusions to domestic and sexual violence occur in some of the earliest written works and feature in ancient stories, such as the rape of Antiope by the Greek king of the gods and sexual predator Zeus. While rape was recognised as a crime in ancient Rome, 'wife beating' for correctional purposes was criminalised only much more recently and remains the norm in some cultures today. Rape is an expression of power. It has long been both a weapon of war and a means of oppressing the vanquished – men as well as women. Following the capture of Berlin by the Red Army in 1945, an estimated 2 million German women and girls were raped by Soviet troops. More recently, in the Rwandan genocide of 1994, many thousands of Tutsi women were subjected to rape, many acquiring HIV as a result. Some were also sexually mutilated in order to destroy their future reproductive capabilities.
Women's position in society has changed over the centuries. In most countries, women are no longer considered to be legal minors: the possessions initially of their fathers and then of their husbands. Attitudes to violence against women have changed in parallel and legislation has followed; for example, during the last 30 years marital rape has been criminalised in most Western countries.
Sadly, abuse and rape remain common in modern societies, whether resource-poor or heavily industrialised. Much is covert, as victims experience fear and shame, which often inhibit disclosure. Many victims wait until the right moment to disclose – perhaps to a practitioner they trust. The health impacts can be immediate or can only become evident much later. In the UK each week two women are killed by their partners, but this is just the tip of the iceberg: many more seek help for nonspecific physical symptoms or mental health problems related to previous abuse.
While anyone can be assaulted or abused, the presence of co-vulnerabilities increases the likelihood. Perpetrators are adept at identifying those with vulnerabilities, whether long-term (e.g. learning or other disability), situational (e.g. being in a conflict zone) or transient (e.g. when someone is under the influence of alcohol or drugs).
Language is dynamic and nomenclature can be problematic, as words inevitably carry connotations (or 'baggage') with them. For example, some writers prefer the term 'abuse' to 'violence' as it is more inclusive; it may make it clearer that the damage is not merely physical, but mental, lasting longer than the processes of physical healing and going deeper than th