290
BATTERED WIVES
(b) FAMILY VIOLENCE SEEN IN GENERAL PRACTICE
ANTON R.
DEWSBURY, M.B., B.S., M.R.C.G.P., D.P.M, General Practitioner, Birmingham
S
to a more extensive survey, my and I became alert to violence. But is often seamy, and it is easy to overlook unpleasant social factors in the scramble to arrive at a &dquo;diagnosis&dquo; and &dquo;treatment&dquo;. The patient is also initially pleased to be able to conceal the sordid side of her life, out of a feeling of guilt and social failure; so unless care is taken, doctor and patient can collude to sweep the whole matter unobservedly under the carpet. It requires a conscious effort to remember to ask irritable, badtempered, and aggressive people, whether anyone in the family has been actually physically harmed. Such people are often pleased to be relieved of their guilty secret, in the same way as depressed patients are relieved to discuss suicide and their feelings towards self-harm. One learns to ask the direct question: &dquo;Have these difficulties or feelings ever led to serious physical harm?&dquo; a
pilot study
partners reality
METHOD IN THIS study, cases in which one marital partner battered the other were identified within a group-practice population. The population at risk was 13,000, and lived in a modestly prosperous middle-class suburb of a Midland city (density 4,800 people per square kilometer). The practice consisted of five general practitioners and ancillary staff. When cases were identified, they were notified to the author. The following results derive from survey of the patients’ records and from some personal knowledge of most of the subjects. No attempt was made at this stage to validate or amplify the data. In this sense, and because they derive from a limited population, any generalizations must remain speculative. We defined persons as battered when they had been subjected to repeated diliberate physical assult including at least one experience of moderate injury (battery). In the study, no distinction was made between legal marriage and cohabitation. A &dquo;wife&dquo; could be any female involved in a continuing relationship lasting more than six months. A &dquo;husband&dquo; was also similarly defined. The study lasted one year. There are four areas of interest: &dquo;wives&dquo; (i) The The children (iii) The &dquo;husbands&dquo; (iv) The overall relationships
(ii)
THE WIVES FIFTEEN BATTERED wives were identified in the practice over a year. This is equivalent to an incidence of 1.15 per 1,000. There was, however, considerable difference between the number of cases identified on the list of each doctor (see Table I). The author identified 3.75 battered wives per 1,000 on his personal list, which, however, has
a very high proportion of newly registered patients-a fact indicative of circumstances that might be expected temporarily to increase the violence of disturbed marriages. Unhappy and unsettled people are likely to move more frequently, while moving tends to be associated with a cluster of life-events like new jobs, new schools, new friends, and loss of relatives all of which throw strains on a marriage. All fifteen cases had experienced marked bruising which was often seen to be extensive (see Table II). Two patients had received fractures, and three had experienced attempts to strangle them. One was threatened with a knife. In this series, the injuries were less severe than in Dr. Gayford’s series of battered wives who had escaped to a hostel. However, the statistics conceal the plight of the individuals under dry figures. The truth is more com-
plex : Case A A COLOURED girl in her early twenties came to see me with a trivial series of problems. At the end of the interview she mentioned that, before moving into the area she had assulted her children. She sought to reassure me that she was coping, and that she was under supervision by the Department of Social Services. I arranged for the children to be accepted into the local nursery, and she received copious support. A few weeks later I had a telephone call from the local hospital to say that her two children had been admitted, one with a fractured skull. It seemed that she had repeatedly pestered the father of her children, seeking marriage. Eventually her tantrums brought a response. The children’s father visited her with his friends, she told me, pulled her from the house, assaulted and kicked her, throwing her against the car while his friends looked on. Certainly there were multiple bruises in support of her story. She called the police, who were unwilling to interfere in a &dquo;domestic matter&dquo;. In impotent rage, and seeing her husband’s face in his children, she threw them downstairs. Hence the child’s fractured skull. She had considerable help prior to the court hearing. But she exploded one day to me: &dquo;You can’t help. You can’t know what it is like to be coloured in a white country. Everyone is prejudiced. No white person can ever understand&dquo;. She came before the court, but slipped home, and during the recess in the court hearing, committed suicide. This case illustrated several points; the suddenness with which a contained situation becomes a disaster; how family aggression can take many forms-assults between spouses, battery of children, over doses, crimi-
Downloaded from rsh.sagepub.com at Bobst Library, New York University on June 2, 2015
291 TABLE I
nal violence and suicide; how the role of the law is open to review. Moreover she was right in that despite much expert and professional support, we failed to &dquo;help&dquo; her. Case B THERE WAS
&dquo;Wives&dquo;
of &dquo;ritual sadism&dquo;, bv which I associated with the sexual act. The husband’s sexual fantasies became increasingly &dquo;wayout&dquo; and aggressive. Among many incidents of sadistic behaviour, he once tied his wife down, and after torturing her by sticking pins in her, carved out his name across her chest and breasts with a razor blade. The wife gave every appearance of a normal healthy woman caught in a nightmare situation, from which she mean
one case
cruelty
*Equivalent to
3.75 per 1,000
presently escaped. status: Although many of the wives were disturbed or distressed, their &dquo;illnesses&dquo; fell under a variety of psychiatric diagnoses (see Tables III and IV). A third of the patients showed gross personality disorders, scars of an adverse upbringing. A further third
Psychiatric
TABLE II
&dquo;Wives&dquo; Violence and injuries
showed neurotic reactions. Psychosis, (major mental illness) was uncommon; but where it did occur, it was often impossible to decide whether it was the cause of, or provoked by the marital disputes that engulfed them.
Mental hospital admissions (see Table v) were frequent among these women, and three had had electroconvulsive therapy. The combination of physical, psychiatric, and social dysfunction leads to heavy demands on the National Health Service of those in adverse personal circumstances.z In these &dquo;socially dependent persons&dquo;3 there may be several agencies often working alongside one another, unaware of each other’s existence.
*Categories not mutually exclusive; thus ALL &dquo;wives&dquo; had bruising.
TABLE III &dquo;Wives&dquo;
by Principal Psychopathology
Two wives had had previous experience of heroin. This was an unexpected finding in a middle-class practice. The drug abuse formed part of the general
Drug abuse: picture
of
psychopathy.
Abortion: There
four terminations of pregnancy abortions among the fifteen women. When one comes to consider the future of the children of these marriages it is not impossible to imagine that if these terminations had been refused the list of atrocities would have been even greater. and
were
probably two criminal
Separation: proved a real problem for many wives. Two of the wives took out legal injunctions preventing the &dquo;husbands&dquo; from returning to the family home. Although they appreciated the danger of the continued relationship, in both cases they let the husband wheedle
TABLE IV
himself back into the marital bed. Both of these husbands had, at other times, broken into the houses as a prelude to vicious attack. A proportion of the women found that attempts at separation led to intense anxiety and subsequent reunion.
J. Bowlby4 has suggested that violence sends the immature instinctively for refuge to the closest relationship, the pair-bonded partner, in this case the husband----even when he is the aggressor. In this way aggression within a pair-bonded relationship leads not just to hate, but to intense ambivalence, with the hate counterbalanced by re-awakened dependency. The girl’s choice of husband is commonly modeled on father, faults and all (Table VI). In early life innate forces lead the infant to select certain persons, usually
&dquo;Wives&dquo;
Additional Factors in
*Categories
not
mutually exclusive
Downloaded from rsh.sagepub.com at Bobst Library, New York University on June 2, 2015
Psychopathology
292 the parents, for strong affection bonds. It is the fantasy of these early pair-bonds which appear to be reawakened at puberty by the sex-hormones. Because these forces are blind and instinctive, they can work to the disadvantage of the individual. By scientific skulduggery the goose can be pair-bonded even to a dog kennel and mourn its loss4. The young girl’s choice of an aggressive mate is often a similar knavish trick of
TABLE V &dquo;Wives&dquo;
nature.
Conversely, the failure to form affection bonds as a child make adult mate selection more difficult. The process which relates the childhood experience to the choice of marital partner is known as Assortive Matings. It was a key force in nearly half the wives. Norman Kreitman6z, has shown that living alongside a sick partner within a disturbed relationship can cause neurotic illness in even the fittest of wives. This applied to a further third. THE CHILDREN OF THE PRESENT PARTNERS IN THIS series of fifteen families (See Table VII) two children were certainly battered. Twelve had been at some time removed either to the care of the local authority or to more distant relatives. A further eight were known to have evidence of serious neurotic disturbance. In family violence one sees a clear association between child battery and wife battery 1,8; moreover, the violence tends to be perpetuated from one generation to another to a frightening degree’.
Case C ONE HUSBAND was injured when, as a boy of three, his angry mother threw a fork at his brother, missed, and hit the subject in the eye. The eye was subsequently enucleated. From then on he had a chronic state of anxiety, which led in adulthood to alcoholism and violence. Four of his children show emotional disturbances including one teenager with (treated) alcoholism. So the contagion of violence had reached the third generation.
TABLE VI &dquo;Wives&dquo; &dquo;Identification&dquo; between childhood and adulthood:
I
Eight cases,
insufficient data
THE &dquo;HUSBANDS&dquo; SEVEN OF the &dquo;husbands&dquo; were also patients of the practice. This was less than might have been expected, because of the tendency in disturbed marriages for husband and wife to register with different doctors (see Table VIII). This is still a high pick-up rate of aggressive husbands when compared with social agencies or psychiatric outpatients. In a study of 187 consecutive outpatients to a psychiatric clinic, nine battered wives were identified, but only two aggressive husbands’°. This implies that general practice is a rich seam to mine. What caused the husbands’ aggression (see Table IX)&dquo;? There were no cases of major mental illness. The overall picture was of personality difficulties, often aggravated by physical causes, especially alcohol.
Personality
Disorders:
Jealousy
of morbid
TABLE VII Children of Present Partners
proportions
apparent in two men. An irritable and aggressive temperament manifested in six husbands. One of these
was
had fears of going berserk and causing major carnage: he drank to relieve the tension from the fear, but this did not prevent the occasional venting of aggression. Ritual sadism (see &dquo;wives&dquo;) provided one caste.
*Firm
diagnosis of cause
Alcohol
possible
TABLE VIII
Physical frequently associated with assaults, although only two patients came within a strict definition of alcoholism. Alcohol can be construed as being relevant in a number of ways-from the immediate effect of a few drinks, through personality change following chronic intoxication, to the irritable causes:
not
was
Downloaded from rsh.sagepub.com at Bobst Library, New York University on June 2, 2015
&dquo;Husbands&dquo; of Cases
293 state of withdrawal. If one includes all these, it becomes difficult to exclude alcohol in any single case; conversely
TABLE IX &dquo;Husbands&dquo;
nearly all men have a drink occasionally-and few have
hands on their wives at some time! Reduced control over aggression may follow head injury, epilepsy or other cerebral conditions’2. Marital strife turned to battery in one family after the husband had a severe coronary thrombosis with resuscitation, which probably left minimal brain damage. It was difficult to gain co-operation from the men for detailed case studies. In order to understand the enigma of male aggression, I was forced to extrapolate by investigating a younger age group. The staff of an L.H.A. Assessment Centre within the practice were able to select twenty boys who had shown problems of physical aggression directed at family, peers and staff. These &dquo;fathers of the future&dquo; were well documented, and their vital statistics allowed one to speculate on the origin of aggressive behaviour (see Table X), which might later be released by alcohol in adult life. Brain damage and illness was apparent in a minority (20 per cent). In the remainder psychosocial causes were the more obvious explanation. The boys came from homes where parental affection was diluted by large families, illegitimacy, broken homes, and premature death of parents. Social training had usually been erratic and many children had been neglected, starved, or battered. Most had limited verbal abilities from lack of social stimulation. Clearly aggression was used where a brighter child would have resolved the problem with words. One child, in particular, reminded me of a jealous husband. He craved affection, but, when any female member of the staff sought to leave him to get about her daily business, she risked severe attack. He could not tolerate the threat of loss. Dr. Chance reports that the threat of loss within a conflict situation is virtually the only circumstance in which an adult male monkey will attack his female partner’3.
by Principal Psychopathology
not laid
THE OVERALL RELATIONSHIP THERE IS a raised incidence of cases from cultures foreign to the Midlands. In some cultures, West Indian and Irish catholic expecially, quantity rather than quality of children seems a powerful social force. Yet it is not certain that physical violence is necessarily raised when individuals from these races are within their own community, constrained by the social forces that their separate communities provide. Two factors seem important. The first is alienation. These persons often have different cultural backgrounds from the society in which they live, and/or different backgrounds from their spouses; they may find repeated rebuff of the basic concepts and philosophies on which their lives are based. Secondly, as family size increases, the parent bond has to be diluted between more brothers and sisters. Immigrant families tend to suffer both alienation and pair bond dilution. The patient (case A) who took her life had lived in three widely spaced nations, and had fifteen siblings and five step-siblings diluting parental affection to an irreducible minimum. There is one final puzzle, implied by the title of the conference, &dquo;Battered Wives&dquo;. Why never battered husbands? In this study we looked for but failed to find battery of any husband in the practice. There were two injured males, one before and one after the period of observation ; but then, perhaps, the exceptions prove the rules. An alcoholic psychopath knifed her husband. The other
*
Temper also **Alcohol also
a a
contributory contributory
factor in further 3 patients factor in further 2-6 patients
TABLE X
Twenty boys from an L.H.A. assessment centre, selected by staff as showing physical aggression to family (parents or siblings), peers or staff.
case was
from
an
increasingly violent homosexual rela-
tionship.
It would seem that both men and women experience unsuitable upbringings, often with excessive discipline, loss of parents or dilution of the parent bond by other siblings or re-marriage, even use of alcohol and drugs. Both can be aggressive-but in different ways. One wife I was counselling took an overdose sufficient to have her on dialysis for three days, when I sought to change her appointment in order to get to the opera on time! This is aggression, but male aggression is often more extra-punitive, and dysfunctional-in basic
English-brutal.
This brutal component in males appears to stem from the effect of male hormone on the infant brain, reinforced by the sex hormones at adolescence’4. It is a force that contributes to delinquency, murder and war-all predominantly male activities. Yet aggression can be used constructively to ensure social order and structurei5. The last decade has shown that women can be relieved of excessive fertility without loss of femininity. The challenge for this decade is to control brutality without loss of masculinity. Until then the treatment of family violence will be largely a matter of counselling and coping. REFERENCES 1
2
3
GAYFORD, J. J. (1975), Wife battering. A Preliminary survey of 100 cases. British Medical Journal, 1, 194. COOK, N. J. and GRANT, I. W. B. (1975), Cost to the N.H.S. of social outcasts with organic disease. British Medical Journal, 2, 132. OLIVER, J. E. and Cox, J. (1973), A family kindred with ill-used children, British Journal of Psychiatry, 123, 81.
Downloaded from rsh.sagepub.com at Bobst Library, New York University on June 2, 2015
294 4
BOWLBY, John (1969), Attachment and Loss, Vol. 1. DOMINIAN, J. (1968), Marital Breakdown. 6 HAGNELL, O. and KREITMAN, K. (1974), Mental illness in married 293. pairs in a total population, British Journal of Psychiatry, 125, 7 OVENSTONE, I. M. K. (1973), The development of neurosis in the wives of neurotic men, British Journal of Psychiatry, 122, 35. 8 SMITH, S. M., HANSON, R. and NOBLE, S. (1974), Social Aspects of the battered baby syndrome, British Journal o f Psychiatry, 125, 568. 9 OLIVER, J. E. and TAYLOR, A. (1971), Five generations of ill-treated children in one family, British Journal of Psychiatry, 119, 473.
10
5
(c)
Lecturer in Social
N the 1870s Frances Power Cobbe, Victorian feminist, drew attention
undergone by working-class
125, 433. 12 BEHRMAN,
S.
(1975), Hostility
to kith and
kin, British Medical
Journal, 2, 539. 13
14 15
of Ethology, Uffculme Clinic, CHANCE, M.R. A., Department communication).
Birmingham, (personal
GRAY, J. (1971), The psychology of fear and STORR, A. (1968), Human aggression.
stress.
an
Work, North London Polytechnic
outstanding
to the sufferwives at the
-
disagree. In considering social work in its relation to battered women, an important question to be asked is why have social workers been unwilling or unable to perceive the problem? Until well after the setting up of Chiswick problem
psychiatric outpatients (in preparation). SCOTT, P. D. (1974), Battered wives, British Journal of Psychiatry,
B.A.
hands of their husbands. In order to draw attention to these horrors she wrote a pamphlet called Wife Torture. She was especially concerned that such women had no means of escaping their husbands, and as a result of her efforts a Matrimonial Causes Act was passed in 18781 whereby magistrates’ Courts were given the power to grant a legal separation order, with maintenance, in cases where the husband had been convicted of aggravated assault, and also to grant the women custody of her children in such cases. That was a hundred years ago, yet today wife beating still persists, and the same problem has surfaced again almost accidentally, as those who have heard how Chiswick Women’s Aid began, will know. I begin therefore by drawing your attention to the persistence of this problem and to its submerged nature. It is a problem that has been consistently ignored. Feminists have been the only group initially willing to campaign around this issue. It should be stated at the outset that this paper arises from more general theoretical work on the relationship of the Welfare State to the position of women since the beginning of the Industrial Revolution2. It is not based on a particular piece of empirical research, and the propositions put forward will accordingly be of a more general and speculative nature. As well, however, as deriving from a larger-scale theoretical study it is informed by the author’s personal experience of participating in the setting up of a refuge for battered women, and also as a member of the BASW (British Association of Social Workers) Working Party on Violence in the Home. It represents the personal view of a social worker and not any official view of social workers, a view moreover with which many social workers may
Women’s Aid the
SIMS, A. and DEWSBURY, A. R. (1975), Battered wives attending
A SOCIAL WORKER’S VIEWPOINT
MISS E. WILSON,
ings
11
was never
discussed
as a
problem whereas baby battering was and although many social workers must have seen many instances of battered women, this was usually perceived as one particular way in which marital malfunctioning manifested itself, rather than as a special kind of probdiscrete
-
-
lem. SOCIAL WORK IN THE WELFARE STATE IN ORDER to understand why social workers have been ineffective in the face of this problem it is necessary to look more generally at the position of social workers today, at the nature of their work in the post-war Welfare State apparatus, and at the particular pressures upon them in the current crisis. Social work has been in a phase of expansion ever since the end of the Second World War. During the War a number of factors had converged to make possible and indeed inevitable the organization of the postwar provision loosely known as the Welfare State. Once it was needed as a fighting and working force to achieve military victory the organized labour movement was able to make certain demands for a new deal after the war ended full employment policies, the NHS, new social security arrangements and the 1944 Education Act. At the same time certain features of the War, notably the evacuation of slum children, had made people generally far more aware of the existence of poverty, child neglect and family breakdown. Social workers had been in demand during the War to organize evacuation programmes, provision for those who had been bombed out, and other emergency services3. The Beveridge Report inaugurated a new era for social work and welfare provision. Before World War II the main focus of welfare provision had been the worker himself; after World ’fv’ar II the focus became the family. To state this so crudely is an oversimplification; concern for family welfare had been a feature of earlier legislation as well as, for example, some of the welfare provisions brought in by Lloyd George before the First World War. The welfare of the worker has continued to be a preoccupation until the present day, but it is true to say that the post-war period has seen an intensification
Downloaded from rsh.sagepub.com at Bobst Library, New York University on June 2, 2015
-
BATTERED WIVES
(b) FAMILY VIOLENCE SEEN IN GENERAL PRACTICE
ANTON R.
DEWSBURY, M.B., B.S., M.R.C.G.P., D.P.M, General Practitioner, Birmingham
S
to a more extensive survey, my and I became alert to violence. But is often seamy, and it is easy to overlook unpleasant social factors in the scramble to arrive at a &dquo;diagnosis&dquo; and &dquo;treatment&dquo;. The patient is also initially pleased to be able to conceal the sordid side of her life, out of a feeling of guilt and social failure; so unless care is taken, doctor and patient can collude to sweep the whole matter unobservedly under the carpet. It requires a conscious effort to remember to ask irritable, badtempered, and aggressive people, whether anyone in the family has been actually physically harmed. Such people are often pleased to be relieved of their guilty secret, in the same way as depressed patients are relieved to discuss suicide and their feelings towards self-harm. One learns to ask the direct question: &dquo;Have these difficulties or feelings ever led to serious physical harm?&dquo; a
pilot study
partners reality
METHOD IN THIS study, cases in which one marital partner battered the other were identified within a group-practice population. The population at risk was 13,000, and lived in a modestly prosperous middle-class suburb of a Midland city (density 4,800 people per square kilometer). The practice consisted of five general practitioners and ancillary staff. When cases were identified, they were notified to the author. The following results derive from survey of the patients’ records and from some personal knowledge of most of the subjects. No attempt was made at this stage to validate or amplify the data. In this sense, and because they derive from a limited population, any generalizations must remain speculative. We defined persons as battered when they had been subjected to repeated diliberate physical assult including at least one experience of moderate injury (battery). In the study, no distinction was made between legal marriage and cohabitation. A &dquo;wife&dquo; could be any female involved in a continuing relationship lasting more than six months. A &dquo;husband&dquo; was also similarly defined. The study lasted one year. There are four areas of interest: &dquo;wives&dquo; (i) The The children (iii) The &dquo;husbands&dquo; (iv) The overall relationships
(ii)
THE WIVES FIFTEEN BATTERED wives were identified in the practice over a year. This is equivalent to an incidence of 1.15 per 1,000. There was, however, considerable difference between the number of cases identified on the list of each doctor (see Table I). The author identified 3.75 battered wives per 1,000 on his personal list, which, however, has
a very high proportion of newly registered patients-a fact indicative of circumstances that might be expected temporarily to increase the violence of disturbed marriages. Unhappy and unsettled people are likely to move more frequently, while moving tends to be associated with a cluster of life-events like new jobs, new schools, new friends, and loss of relatives all of which throw strains on a marriage. All fifteen cases had experienced marked bruising which was often seen to be extensive (see Table II). Two patients had received fractures, and three had experienced attempts to strangle them. One was threatened with a knife. In this series, the injuries were less severe than in Dr. Gayford’s series of battered wives who had escaped to a hostel. However, the statistics conceal the plight of the individuals under dry figures. The truth is more com-
plex : Case A A COLOURED girl in her early twenties came to see me with a trivial series of problems. At the end of the interview she mentioned that, before moving into the area she had assulted her children. She sought to reassure me that she was coping, and that she was under supervision by the Department of Social Services. I arranged for the children to be accepted into the local nursery, and she received copious support. A few weeks later I had a telephone call from the local hospital to say that her two children had been admitted, one with a fractured skull. It seemed that she had repeatedly pestered the father of her children, seeking marriage. Eventually her tantrums brought a response. The children’s father visited her with his friends, she told me, pulled her from the house, assaulted and kicked her, throwing her against the car while his friends looked on. Certainly there were multiple bruises in support of her story. She called the police, who were unwilling to interfere in a &dquo;domestic matter&dquo;. In impotent rage, and seeing her husband’s face in his children, she threw them downstairs. Hence the child’s fractured skull. She had considerable help prior to the court hearing. But she exploded one day to me: &dquo;You can’t help. You can’t know what it is like to be coloured in a white country. Everyone is prejudiced. No white person can ever understand&dquo;. She came before the court, but slipped home, and during the recess in the court hearing, committed suicide. This case illustrated several points; the suddenness with which a contained situation becomes a disaster; how family aggression can take many forms-assults between spouses, battery of children, over doses, crimi-
Downloaded from rsh.sagepub.com at Bobst Library, New York University on June 2, 2015
291 TABLE I
nal violence and suicide; how the role of the law is open to review. Moreover she was right in that despite much expert and professional support, we failed to &dquo;help&dquo; her. Case B THERE WAS
&dquo;Wives&dquo;
of &dquo;ritual sadism&dquo;, bv which I associated with the sexual act. The husband’s sexual fantasies became increasingly &dquo;wayout&dquo; and aggressive. Among many incidents of sadistic behaviour, he once tied his wife down, and after torturing her by sticking pins in her, carved out his name across her chest and breasts with a razor blade. The wife gave every appearance of a normal healthy woman caught in a nightmare situation, from which she mean
one case
cruelty
*Equivalent to
3.75 per 1,000
presently escaped. status: Although many of the wives were disturbed or distressed, their &dquo;illnesses&dquo; fell under a variety of psychiatric diagnoses (see Tables III and IV). A third of the patients showed gross personality disorders, scars of an adverse upbringing. A further third
Psychiatric
TABLE II
&dquo;Wives&dquo; Violence and injuries
showed neurotic reactions. Psychosis, (major mental illness) was uncommon; but where it did occur, it was often impossible to decide whether it was the cause of, or provoked by the marital disputes that engulfed them.
Mental hospital admissions (see Table v) were frequent among these women, and three had had electroconvulsive therapy. The combination of physical, psychiatric, and social dysfunction leads to heavy demands on the National Health Service of those in adverse personal circumstances.z In these &dquo;socially dependent persons&dquo;3 there may be several agencies often working alongside one another, unaware of each other’s existence.
*Categories not mutually exclusive; thus ALL &dquo;wives&dquo; had bruising.
TABLE III &dquo;Wives&dquo;
by Principal Psychopathology
Two wives had had previous experience of heroin. This was an unexpected finding in a middle-class practice. The drug abuse formed part of the general
Drug abuse: picture
of
psychopathy.
Abortion: There
four terminations of pregnancy abortions among the fifteen women. When one comes to consider the future of the children of these marriages it is not impossible to imagine that if these terminations had been refused the list of atrocities would have been even greater. and
were
probably two criminal
Separation: proved a real problem for many wives. Two of the wives took out legal injunctions preventing the &dquo;husbands&dquo; from returning to the family home. Although they appreciated the danger of the continued relationship, in both cases they let the husband wheedle
TABLE IV
himself back into the marital bed. Both of these husbands had, at other times, broken into the houses as a prelude to vicious attack. A proportion of the women found that attempts at separation led to intense anxiety and subsequent reunion.
J. Bowlby4 has suggested that violence sends the immature instinctively for refuge to the closest relationship, the pair-bonded partner, in this case the husband----even when he is the aggressor. In this way aggression within a pair-bonded relationship leads not just to hate, but to intense ambivalence, with the hate counterbalanced by re-awakened dependency. The girl’s choice of husband is commonly modeled on father, faults and all (Table VI). In early life innate forces lead the infant to select certain persons, usually
&dquo;Wives&dquo;
Additional Factors in
*Categories
not
mutually exclusive
Downloaded from rsh.sagepub.com at Bobst Library, New York University on June 2, 2015
Psychopathology
292 the parents, for strong affection bonds. It is the fantasy of these early pair-bonds which appear to be reawakened at puberty by the sex-hormones. Because these forces are blind and instinctive, they can work to the disadvantage of the individual. By scientific skulduggery the goose can be pair-bonded even to a dog kennel and mourn its loss4. The young girl’s choice of an aggressive mate is often a similar knavish trick of
TABLE V &dquo;Wives&dquo;
nature.
Conversely, the failure to form affection bonds as a child make adult mate selection more difficult. The process which relates the childhood experience to the choice of marital partner is known as Assortive Matings. It was a key force in nearly half the wives. Norman Kreitman6z, has shown that living alongside a sick partner within a disturbed relationship can cause neurotic illness in even the fittest of wives. This applied to a further third. THE CHILDREN OF THE PRESENT PARTNERS IN THIS series of fifteen families (See Table VII) two children were certainly battered. Twelve had been at some time removed either to the care of the local authority or to more distant relatives. A further eight were known to have evidence of serious neurotic disturbance. In family violence one sees a clear association between child battery and wife battery 1,8; moreover, the violence tends to be perpetuated from one generation to another to a frightening degree’.
Case C ONE HUSBAND was injured when, as a boy of three, his angry mother threw a fork at his brother, missed, and hit the subject in the eye. The eye was subsequently enucleated. From then on he had a chronic state of anxiety, which led in adulthood to alcoholism and violence. Four of his children show emotional disturbances including one teenager with (treated) alcoholism. So the contagion of violence had reached the third generation.
TABLE VI &dquo;Wives&dquo; &dquo;Identification&dquo; between childhood and adulthood:
I
Eight cases,
insufficient data
THE &dquo;HUSBANDS&dquo; SEVEN OF the &dquo;husbands&dquo; were also patients of the practice. This was less than might have been expected, because of the tendency in disturbed marriages for husband and wife to register with different doctors (see Table VIII). This is still a high pick-up rate of aggressive husbands when compared with social agencies or psychiatric outpatients. In a study of 187 consecutive outpatients to a psychiatric clinic, nine battered wives were identified, but only two aggressive husbands’°. This implies that general practice is a rich seam to mine. What caused the husbands’ aggression (see Table IX)&dquo;? There were no cases of major mental illness. The overall picture was of personality difficulties, often aggravated by physical causes, especially alcohol.
Personality
Disorders:
Jealousy
of morbid
TABLE VII Children of Present Partners
proportions
apparent in two men. An irritable and aggressive temperament manifested in six husbands. One of these
was
had fears of going berserk and causing major carnage: he drank to relieve the tension from the fear, but this did not prevent the occasional venting of aggression. Ritual sadism (see &dquo;wives&dquo;) provided one caste.
*Firm
diagnosis of cause
Alcohol
possible
TABLE VIII
Physical frequently associated with assaults, although only two patients came within a strict definition of alcoholism. Alcohol can be construed as being relevant in a number of ways-from the immediate effect of a few drinks, through personality change following chronic intoxication, to the irritable causes:
not
was
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&dquo;Husbands&dquo; of Cases
293 state of withdrawal. If one includes all these, it becomes difficult to exclude alcohol in any single case; conversely
TABLE IX &dquo;Husbands&dquo;
nearly all men have a drink occasionally-and few have
hands on their wives at some time! Reduced control over aggression may follow head injury, epilepsy or other cerebral conditions’2. Marital strife turned to battery in one family after the husband had a severe coronary thrombosis with resuscitation, which probably left minimal brain damage. It was difficult to gain co-operation from the men for detailed case studies. In order to understand the enigma of male aggression, I was forced to extrapolate by investigating a younger age group. The staff of an L.H.A. Assessment Centre within the practice were able to select twenty boys who had shown problems of physical aggression directed at family, peers and staff. These &dquo;fathers of the future&dquo; were well documented, and their vital statistics allowed one to speculate on the origin of aggressive behaviour (see Table X), which might later be released by alcohol in adult life. Brain damage and illness was apparent in a minority (20 per cent). In the remainder psychosocial causes were the more obvious explanation. The boys came from homes where parental affection was diluted by large families, illegitimacy, broken homes, and premature death of parents. Social training had usually been erratic and many children had been neglected, starved, or battered. Most had limited verbal abilities from lack of social stimulation. Clearly aggression was used where a brighter child would have resolved the problem with words. One child, in particular, reminded me of a jealous husband. He craved affection, but, when any female member of the staff sought to leave him to get about her daily business, she risked severe attack. He could not tolerate the threat of loss. Dr. Chance reports that the threat of loss within a conflict situation is virtually the only circumstance in which an adult male monkey will attack his female partner’3.
by Principal Psychopathology
not laid
THE OVERALL RELATIONSHIP THERE IS a raised incidence of cases from cultures foreign to the Midlands. In some cultures, West Indian and Irish catholic expecially, quantity rather than quality of children seems a powerful social force. Yet it is not certain that physical violence is necessarily raised when individuals from these races are within their own community, constrained by the social forces that their separate communities provide. Two factors seem important. The first is alienation. These persons often have different cultural backgrounds from the society in which they live, and/or different backgrounds from their spouses; they may find repeated rebuff of the basic concepts and philosophies on which their lives are based. Secondly, as family size increases, the parent bond has to be diluted between more brothers and sisters. Immigrant families tend to suffer both alienation and pair bond dilution. The patient (case A) who took her life had lived in three widely spaced nations, and had fifteen siblings and five step-siblings diluting parental affection to an irreducible minimum. There is one final puzzle, implied by the title of the conference, &dquo;Battered Wives&dquo;. Why never battered husbands? In this study we looked for but failed to find battery of any husband in the practice. There were two injured males, one before and one after the period of observation ; but then, perhaps, the exceptions prove the rules. An alcoholic psychopath knifed her husband. The other
*
Temper also **Alcohol also
a a
contributory contributory
factor in further 3 patients factor in further 2-6 patients
TABLE X
Twenty boys from an L.H.A. assessment centre, selected by staff as showing physical aggression to family (parents or siblings), peers or staff.
case was
from
an
increasingly violent homosexual rela-
tionship.
It would seem that both men and women experience unsuitable upbringings, often with excessive discipline, loss of parents or dilution of the parent bond by other siblings or re-marriage, even use of alcohol and drugs. Both can be aggressive-but in different ways. One wife I was counselling took an overdose sufficient to have her on dialysis for three days, when I sought to change her appointment in order to get to the opera on time! This is aggression, but male aggression is often more extra-punitive, and dysfunctional-in basic
English-brutal.
This brutal component in males appears to stem from the effect of male hormone on the infant brain, reinforced by the sex hormones at adolescence’4. It is a force that contributes to delinquency, murder and war-all predominantly male activities. Yet aggression can be used constructively to ensure social order and structurei5. The last decade has shown that women can be relieved of excessive fertility without loss of femininity. The challenge for this decade is to control brutality without loss of masculinity. Until then the treatment of family violence will be largely a matter of counselling and coping. REFERENCES 1
2
3
GAYFORD, J. J. (1975), Wife battering. A Preliminary survey of 100 cases. British Medical Journal, 1, 194. COOK, N. J. and GRANT, I. W. B. (1975), Cost to the N.H.S. of social outcasts with organic disease. British Medical Journal, 2, 132. OLIVER, J. E. and Cox, J. (1973), A family kindred with ill-used children, British Journal of Psychiatry, 123, 81.
Downloaded from rsh.sagepub.com at Bobst Library, New York University on June 2, 2015
294 4
BOWLBY, John (1969), Attachment and Loss, Vol. 1. DOMINIAN, J. (1968), Marital Breakdown. 6 HAGNELL, O. and KREITMAN, K. (1974), Mental illness in married 293. pairs in a total population, British Journal of Psychiatry, 125, 7 OVENSTONE, I. M. K. (1973), The development of neurosis in the wives of neurotic men, British Journal of Psychiatry, 122, 35. 8 SMITH, S. M., HANSON, R. and NOBLE, S. (1974), Social Aspects of the battered baby syndrome, British Journal o f Psychiatry, 125, 568. 9 OLIVER, J. E. and TAYLOR, A. (1971), Five generations of ill-treated children in one family, British Journal of Psychiatry, 119, 473.
10
5
(c)
Lecturer in Social
N the 1870s Frances Power Cobbe, Victorian feminist, drew attention
undergone by working-class
125, 433. 12 BEHRMAN,
S.
(1975), Hostility
to kith and
kin, British Medical
Journal, 2, 539. 13
14 15
of Ethology, Uffculme Clinic, CHANCE, M.R. A., Department communication).
Birmingham, (personal
GRAY, J. (1971), The psychology of fear and STORR, A. (1968), Human aggression.
stress.
an
Work, North London Polytechnic
outstanding
to the sufferwives at the
-
disagree. In considering social work in its relation to battered women, an important question to be asked is why have social workers been unwilling or unable to perceive the problem? Until well after the setting up of Chiswick problem
psychiatric outpatients (in preparation). SCOTT, P. D. (1974), Battered wives, British Journal of Psychiatry,
B.A.
hands of their husbands. In order to draw attention to these horrors she wrote a pamphlet called Wife Torture. She was especially concerned that such women had no means of escaping their husbands, and as a result of her efforts a Matrimonial Causes Act was passed in 18781 whereby magistrates’ Courts were given the power to grant a legal separation order, with maintenance, in cases where the husband had been convicted of aggravated assault, and also to grant the women custody of her children in such cases. That was a hundred years ago, yet today wife beating still persists, and the same problem has surfaced again almost accidentally, as those who have heard how Chiswick Women’s Aid began, will know. I begin therefore by drawing your attention to the persistence of this problem and to its submerged nature. It is a problem that has been consistently ignored. Feminists have been the only group initially willing to campaign around this issue. It should be stated at the outset that this paper arises from more general theoretical work on the relationship of the Welfare State to the position of women since the beginning of the Industrial Revolution2. It is not based on a particular piece of empirical research, and the propositions put forward will accordingly be of a more general and speculative nature. As well, however, as deriving from a larger-scale theoretical study it is informed by the author’s personal experience of participating in the setting up of a refuge for battered women, and also as a member of the BASW (British Association of Social Workers) Working Party on Violence in the Home. It represents the personal view of a social worker and not any official view of social workers, a view moreover with which many social workers may
Women’s Aid the
SIMS, A. and DEWSBURY, A. R. (1975), Battered wives attending
A SOCIAL WORKER’S VIEWPOINT
MISS E. WILSON,
ings
11
was never
discussed
as a
problem whereas baby battering was and although many social workers must have seen many instances of battered women, this was usually perceived as one particular way in which marital malfunctioning manifested itself, rather than as a special kind of probdiscrete
-
-
lem. SOCIAL WORK IN THE WELFARE STATE IN ORDER to understand why social workers have been ineffective in the face of this problem it is necessary to look more generally at the position of social workers today, at the nature of their work in the post-war Welfare State apparatus, and at the particular pressures upon them in the current crisis. Social work has been in a phase of expansion ever since the end of the Second World War. During the War a number of factors had converged to make possible and indeed inevitable the organization of the postwar provision loosely known as the Welfare State. Once it was needed as a fighting and working force to achieve military victory the organized labour movement was able to make certain demands for a new deal after the war ended full employment policies, the NHS, new social security arrangements and the 1944 Education Act. At the same time certain features of the War, notably the evacuation of slum children, had made people generally far more aware of the existence of poverty, child neglect and family breakdown. Social workers had been in demand during the War to organize evacuation programmes, provision for those who had been bombed out, and other emergency services3. The Beveridge Report inaugurated a new era for social work and welfare provision. Before World War II the main focus of welfare provision had been the worker himself; after World ’fv’ar II the focus became the family. To state this so crudely is an oversimplification; concern for family welfare had been a feature of earlier legislation as well as, for example, some of the welfare provisions brought in by Lloyd George before the First World War. The welfare of the worker has continued to be a preoccupation until the present day, but it is true to say that the post-war period has seen an intensification
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-
