Abuse Freedom United

graGRACE N ANGELScenangel writes "Helping Battered Women
Michael K. Gilbertson, Ph.D., B.C.E.T.S.

Introduction

Violence is an increasing problem in our society. Police and social scientists have long been concerned with the level of violence in our streets. Juvenile specialists have noted the link between violence at home and the increased likelihood of adolescent crime. Of the adults that the courts have remanded to me for treatment, the majority have come from emotionally or physically abusive homes. Even witnessing violence can leave emotional scars as deep as being the recipient of violence.

In this social context, battered women deserve a special focus. The battered women themselves are of course the primary victims. But the secondary victims are their children. Boys who witness their mothers being battered are more likely to commit acts of violence themselves. Girls who observe domestic violence are more likely to tolerate abusive partners as adults, thus subjecting another generation to the same sad dynamics.

So, how do we intervene? The answer is related to questions that colleagues and I have often asked ourselves and each other: Why do battered women tolerate the abuse for so long before seeking help? And why, even after receiving help, do they so often return to their abusive partners?

In her ethnographic study, Patricia Gagne (1992) writes of Leah and her abusive husband Andy. After years of violence at Andy's hands, Leah left. A shelter worker helped her relocate. But after several months she returned to Andy. "You know, with everything in my heart and soul I did not want to come back, and why I did I really don't know" (p. 409). This paper proposes some answers to Leah's question. As the problem is multifaceted, likewise, the answers are complex. These women are not helped sufficiently, in part because focus at the ecological levels of the state and the community reduces focus on the individual. The reasons for this inadequate response involve the theoretical constructs of status, sexism, and (failure to consider) how systems interact. Systems' interaction explains how victim behavior and social perceptions interact to keep even helpful emphasis off the victims. Systems' interaction also specifically acknowledges mutually interactive aspects of attachment theory and the biochemistry of trauma--received or witnessed.

Understanding the Problem

Bell and Jenkins (1993) reveal the staggering amount of violence in contemporary American inner cities. Equally disturbing to these authors was the amount of life-threatening violence that Black youths witnessed. They were growing up amid victimization of alarming proportions. Not surprisingly, they found that the effects of witnessing violence were *****ulative and that perpetration of violence by the youth was related to the violence witnessed.

Increasingly, researchers are recognizing that an environment of chronic violence and its perceived dangers causes many children to adapt in dysfunctional ways. The maladaptive patterns are usefully understood within the framework of Posttraumatic Stress Disorder (PTSD), (Garbarino, 1992), a point to which I will return later. As I noted earlier, girls who witness battering grow up, in disproportionate numbers, tend to be abused themselves (Waites, 1993). Another way of viewing this is that people who have been directly or indirectly victimized are likely to be victimized again (McFarlane & van der Kolk, 1996).

So, clearly, one point of intervention to break this cycle of violence would involve interrupting domestic violence against women. In the field of cultural anthropology, researchers like Jacquelyn Campbell (1992) have found that, across cultures, wife battering is linked to male dominance and cultural norms that tolerate domestic violence. Because of findings like Campbell's, a solid argument exists that, at the institutional/state level, part of the problem is that legislatures are composed primarily of men--men who are presumably influenced by a culture that encourages them to view women as objects of possession (Gagne, 1992).

Status theory and Marx's theories of power may dovetail here. Longres (1995) cites an experiment by Wendy Harrod where subjects deferred to others who they thought were being paid more. The experiment is used in support of social exchange theory. It could just as well support status theory: more social power flows to those with the most status, a component of which is material possessions. In any case, more power and status accrue to those who possess than to those who are objects of possession, and Marx was undoubtedly correct to presume that those in powerful, high-status positions are unlikely to readily alter their positions (Longres, 1995). But despite a possible reluctance to alter a status quo from which they benefitted, lawmakers have begun to respond to issues of domestic violence. Still, even as laws increasingly begin to reflect our national concern about domestic violence, the rates of battering still climb (Waites, 1993), and women continue to return to abusers--further swelling the domestic abuse numbers.

Could more be done at the ecological level of the community? Campbell (1992) for one feels that the neighborhood level should be the focus of our efforts. In small communities progress was initially slowed by the patriarchal thinking that Van Soest & Bryant (1995) found typical in the United States. Workers at women's crisis shelters have told me that patriarchal factors resulted in de facto sexism when it came time to seek funding for buildings or staff. Despite these formidable difficulties, crisis centers with predominantly female staff and board members exist in most communities with which I am familiar. Still, the rates of spousal abuse show no signs of leveling, and having a safe refuge hasn't prevented many women from returning to be revictimized.

I do not mean to suggest that because neither laws at the state level nor interventions at the community level have halted the rise in wife battering that we should withdraw our attention from either level. Public awareness campaigns addressing domestic violence could benefit from better funding at both levels. And certainly society-wide attention to poverty could only be beneficial since low socioeconomic status correlates with domestic abuse (Whipple & Webster-Stratton, 1989 cited in Webster-Stratton, 1990).

Nevertheless, if we are going to shed light on the vexing problem of why so many battered women put up with abuse and then return to their victimizers when they do have a way out, we must examine the individual. For many Social Workers the discouraging fact remains that despite better laws and shelter programs, most of the women they help will return to the same abuse. We do these women a disservice if we ignore the problem at the intrapsychic level.

So why isn't intrapsychic information about victims of violence more widely assimilated and dispersed? It is not because we lack a systematic body of research that would help us understand victims of trauma. Information about the biochemistry of PTSD, and attachment theory give us a useful series of lenses with which to view revictimization. That the information is not better known to clinicians may be because of the same theoretical constructs I already examined: status theory and theories of sexism.

Social Work, a predominantly female field, has in its recent history taken a dim view of intrapsychic emphasis, linking it with patriarchal Freudian thought and blaming it (among other things) for the perceived failure of the profession to heed the larger social issue of impoverishment during the Great Depression (Simon, 1994). One could argue that assuming an intrapsychic emphasis would not enhance one's professional status as a Social Worker.

Perhaps more central to issues of status and sexism is a legitimate concern among women that any focus that smacks of blaming the victim is inherently unjust. John Longres (1995) elaborates the position of William Ryan (who coined the term "blaming the victim") this way: "Social service workers also blame the victim when they acknowledge the societal causes of problems but intervene only at the level of the individual" (p. 8). If the victims are overwhelmingly female, as in spousal battering, blaming them for their troubles also becomes the crassest sexism.

Is there a way out of this dilemma? Perhaps, but first we must recognize it as a false dilemma. Looking for points of intervention is not the same as blaming the victim. If we feel victims are at fault, we have no need to intervene; we can justify ignoring their plight. But if we wish to help battered women, one possibility is to find ways to enable them to change patterns of behavior. That would be genuine self-empowerment. And it does not mean we have to cease addressing issues at the state or community level. However, we can only help individuals empower themselves if we understand the biochemistry and attachment dynamics of trauma.

Understanding the Problem at the Level of the Individual

Trauma researchers have frequently noted the link between trauma and retraumatization (Browne & Finkelhor, 1986). For our purposes this phenomenon is the statistical tendency to be a victim of repetitive trauma after suffering childhood abuse. Briere & Runtz (1988) found women who had been abused as minors were more likely to have been in abusive adult relationships. Diane Russell (1986) noted in her study that women who had a history of incest were twice as likely to report physical violence in their marital relationships as women who had no such childhood history.

So what may be happening here? Well, colloquially we speak of people who seem to crave danger as "adrenaline junkies." We would be closer to the mark if we dropped the implied moral judgment and looked elsewhere than adrenaline. It is true that a frightening situation produces epinephrine (adrenaline), but it also triggers the release of endogenous opioids (endorphins and enkephalins) whose purpose is to produce analgesia. The ability to inhibit pain in a traumatic situation is an obvious advantage.

There is, however, a downside. Our own opioids are as addictive as exogenous opioids. In an article exploring self-injury in adults, Thompson and his colleagues (1994) noted that release of endogenous opioids had the same reinforcing potential as heroin or morphine. They speculated that individuals may continue harmful behaviors to avoid the discomfort of withdrawal. This fact has led van der Kolk (1989) to describe the resulting "addiction to trauma" as a mechanism for understanding the apparently compulsive behavior of self-abuse that characterizes many trauma victims. The more flagrant forms of self-abuse like cutting on oneself or headbanging may first suggest themselves as addictive behavior, but allowing someone else to do the damage may share the same link to opioids release.

Nor does the effect need to be maintained from childhood until marriage by continual abuse to retain its potency. When people with PTSD were exposed to a stimulus that resembled a trauma occurring two decades earlier, they developed an opioids-mediated analgesia that was equivalent to 8 mg of morphine (Pitman, van der Kolk, Orr, & Greenberg, 1990).

Several women from physically abusive relationships whom I have treated have told me of sensing the familiar buildup of domestic tension, then provoking a fight "just to get it over with." This response is an occasional part of the well known cycle of domestic violence. What is not expected is the answer I often get when I ask about their emotional state as the fighting begins. Several women have thought about it, then spoken of a sense of calm that obviously puzzled them. Given the numbing effects of endogenous opioids, their emotional response to violence may be understandable. Since they do not understand it, their appraisal of their behavior usually invokes shame.

And shame is the bridge to understanding how negative self-appraisal and attachment theory interact with the biochemistry of trauma to further perpetuate the cycle of revictimization. When battered wives were children, those who suffered abuse at the hands of caregivers were at risk to endure understandable threats to their attachment bonds. Disruption to attachment bonds with caregivers due to neglect or abuse produces distorted identity schema resulting in "bad me" appraisals. Not understanding the biochemistry of why they tolerate abuse or feel paradoxically calm when being battered leads abused women to feel shame, which reinforces the negative self-appraisal first put in place by disrupted attachment bonds. So an examination of attachment is in order.

We are biologically programmed to establish a secure bond with our caregivers. This drive is most pronounced under the threat of danger--even if the danger is from our caregivers. Beverly James (1994) uses the phase "trauma bonding" to describe how children are forced by trauma to cling in a nondiscriminating fashion to abusive caregivers no matter what the cost.

The cost is usually to self-esteem. Since children must preserve the attachment bond or the illusion of a pseudoattachment, they do so by what in object relations theory is called "splitting," to convince themselves that their parents are good and the bond is secure. Since "bad parent-good parent" splitting creates too much cognitive dissonance without the aid of traumatic dissociation and amnestic barriers, a more common split is "good parent-bad me." This tendency makes more sense when considering the egocentrism of young children whereby they attribute things happening to them as due to their own actions (Piaget, 1962). Years later many people first traumatized as children feel responsibility for their own abuse and perceive themselves to be unlovable or despicable (van der Kolk, 1996). These dynamics are often encouraged by abusers who generally refuse responsibility for their actions and are only too willing to blame their victims for imagined transgressions.

Once locked into a "bad me" split, children must selectively pursue evidence of their unworthiness. The resulting guilt can only be expiated by punishment. Many of my abused clients have said that they feel a vague sense that they will be punished and that they feel as if they "deserve" such punishment. If this tack seems a little too psychodynamic (dare I say Freudian?), then at least it should be clear how a low sense of self-worth, coupled with overresponsibility, could lead a woman to make excuses for her battering husband.

At this point a reader familiar with the Stockholm Syndrome might wonder if that phenomenon is relevant to the discussion. It might be. Several years ago in Stockholm a bank robber held a woman as hostage for several days in the bank's vault. When rescued, the woman denied that her captor was responsible for her pain. She was in fact quite indignant at the force the police had used to capture her assailant. She seemed to be infatuated with the gunman.

The key here might be the infantilization of the hostage who was dependent upon her captor for food, water, and toilet privileges. Frank Ochberg (1995) thinks this traumatic age regression (my term, not Dr. Ochberg's) accounts for the almost primal gratitude for life's necessities that many hostages feel if they're shown even a little kindness. He specifically links the Stockholm Syndrome with the bond many battered women feel for their abusers.

Lest the above seem too simplistic a portrait of some battered women, a portrait that paints them as largely incompetent, I would add that I have witnessed the above dynamics in very professionally accomplished women. Bessel van der Kolk (1996) finds the same occurrence: "High levels of competence and interpersonal sensitivity often exist side by side with self-hatred . . ." (p. 196).

How widely spread could the above dynamics be? Though overgeneralization should be avoided, aspects of attachment dynamics may account for more revictimization than a skeptic might think. Reviewing previous research, van der Kolk & Fisler (1994) found that a majority of children who experienced abuse or neglect developed disorganized attachment patterns.

Implications for Practice and Policy

Now that a base for understanding revictimization has been suggested, let me begin this section by observing how victim behavior patterns, mediated by trauma addiction and trauma bonding, could interact with systems at the state and community levels to reinforce victim stereotypes. Looking at the repetitive nature of victim behavior without understanding it can lead to reductive labeling. Specifically I have in mind the terms female masochism and Borderline Personality Disorder (assigned overwhelmingly to women). The former term presumes that pain gives psychological gratification without understanding the biochemical basis for the behavior. The latter term presumes an innate character flaw without considering the traumatic etiology. It is significant that Herman and van der Kolk (1987) found that Borderline Personality Disorder was associated with a history of abuse.

Pejorative labeling in our culture can only make it harder for professionals who wish to help battered women to obtain the legal protection and the immediate aid they need. But as I have argued, avoiding labeling by refusing to examine individual behavior keeps Social Workers from intervening effectively at the level we often encounter domestic violence: face to face.

What the above suggests is that in our professional practice we must educate ourselves about the dynamics and biochemistry of PTSD. I have found few things as immediately gratifying to women as when they truly grasp that their behavior is understandable and, by implication, treatable; they are not unworthy, shameful humans. Of course this places the burden on clinicians to master the therapeutic treatments used for trauma-based disorders and a burden on non-clinical Social Workers to know when and to whom to refer.

At the policy level we must be prepared to argue for the treatment intervention time needed to help clients rework complex attachment patterns and deal with actual withdrawal from their own opioids. In an era of managed care it will be a formidable undertaking to argue for more, not less, financial aid at the state and local levels.

Recommendations for Further Research

At this time medications commonly used to help with withdrawal symptoms from exogenous opioids are pretty much limited to Selective Serotonin Reuptake Inhibitors (SSRIs) like fluoxetine to help with the attendant depression and benzodiazepines to calm the patient. In any case, using carefully monitored SSRIs and benzodiazepines for battered women in shelters would be a useful pilot study if carefully designed.

Another promising area could be (are you ready for this?) - acupuncture. Avants and his colleagues (1995) have shown some forms of acupuncture to be beneficial for treating opioids addiction. A pilot study with battered women could be economically designed.

"

Plain Talk About...Wife Abuse

National Institute of Mental Health Division of Scientific and Public Information Plain Talk Series - Ruth Kay, Editor

"To have and to hold...to love and to cherish..."
"Be it ever so humble, there's no place like home."
These sentiments reflect the feelings of most people towards marriage, home, and family - but not all. The surprising fact is that a lot of violence, bringing fear and pain, is reported among family members.

For example, about one-quarter of all murders in the United States take place within the family. Surveys of American couples show that 20 to 50 percent have suffered violence regularly in their marriages. The records indicate that between two and four million incidents of domestic violence occur every single year. Wife abuse is one kind of family violence that probably occurs far more often than most people imagine. The tragedy is that many women suffer this abuse for years without getting help. This flier explores what wife abuse is, who experiences it, some reasons it occurs, the pattern it usually takes, and why women don't get help. Finally, it looks at what women can do if they are abused and how, ultimately, the abuse might be prevented.
WHAT DO WE MEAN BY "WIFE ABUSE"?

Defining wife abuse or wife battering is not easy. For starters, whom are we thinking of when we use the word "wife"? Actually, any woman who maintains an intimate relationship with a man (her husband, ex-husband, boyfriend or lover) could become a battered or abused "wife." The words "abused" or "battered" which are used here do not refer to the normal conflict and stress that occur in all close relationships, but rather to the violence that can cause serious injury and death. In the pamphlet, "Assaults on women: rape and wife-beating," Natalie Jaffe cites a typical description of the kind of physical harm suffered by battered women surveyed in shelters and treatment in California.

"Most injuries were to the head and neck and, in addition to bruises, strangle marks, black eyes, and split lips, resulted in eye damage, fractured jaws, broken noses, and permanent hearing loss. Assaults to the trunk of the body were almost as common and produced a broken collarbone, bruised and broken ribs, a fractured tailbone, internal hemorrhaging, and a lacerated liver."

These are serious consequences of serious assaults. Another serious aspect is that once wife beating occurs, it is likely to happen again and again, with violence getting worse over time.

A CLOSER LOOK AT HOW THE ABUSED WOMAN FEELS

A woman who has been abused over a long period of time is afraid. Not only is she afraid that she, herself, will be seriously hurt, but if she has children, she fears for their safety also. Her feelings of fear link her to all other women, from all classes of society, in similar situations.

Fear might be a woman's first and most immediate feeling during or after a beating, but other negative feelings may surface when she is not in physical danger. The abused woman is apt to develop doubts about herself. She might wonder if she is justified in fearing for her life and calling herself an "abused wife." Most likely, however, a woman who thinks or feels she is being abused, probably is.

Or, she may feel guilty, even though she's done nothing wrong. An abused wife may feel responsible for her husband's violence because in some way she may have provoked him. This has her placing the shame and blame on herself - instead of her abuser. The longer she puts up with the abuse and does nothing to avoid or prevent it, the less she likes herself. Along with the feeling of being a failure, both as a woman and in her marriage, may come a real feeling of being trapped and powerless, with no way out.

WHY DO MEN ABUSE THEIR WIVES?

Instances of wife abuse have been on record in the United States since the 1830s, but only every now and then does it arouse public concern. Generally, public opinion supports traditional family relations and male authority. The battering syndrome is both cause and effect of stereotyped roles and the unequal power relations between men and women. No social class is exempt. Wife abuse occurs in wealthy as well as in poor communities - in middle class as well as in working class families. Over the years it has been tolerated by those who govern community affairs, the courts, medicine, psychiatry, police, schools, and the church. History shows that the helping professions often protected patterns of family authority, unwittingly sanctioning wife abuse rather than condemning it.

Other Factors

Present day society is one in which violence in the movies, on TV, and in the newspapers is familiar and accepted. Many husbands who abuse their wives have learned that violence, especially against women, is okay. They often were abused themselves as children or saw their mothers abused. The battered wife most likely grew up in a similar environment.

There are other psychological reasons. A wife abuser tends to be filled with anger, resentment, suspicion, and tension. He also, underneath all his aggressive behavior, can be insecure and feel like a loser. He may use violence to give vent to the bad feelings he has about himself or his lot in life. Home is one place he can express those feelings without punishment to himself. If he were angry with his boss and struck him, he would pay the price. But all too often he gets away without penalty when he beats his wife. She becomes the target of his vengeance, and he gets the satisfaction he's looking for.

What about the victimized wife? If she accepts her husband's traditional male authority, she may be labeled as immature. If she fights back or if she refuses to sleep with him if he's drunk, she might be accused of being hostile, domineering, and masculine. These are complaints of abused women.

PATTERNS

Familiar patterns of wife abuse often develop in three phases: the tension-building phase, the explosion or the actual beating phase, and the loving phase. The tension builds over a series of small occurrences such as a wife's request for money, her refusal to do all the household chores without her husband's help, her serving a meal not pleasing to him, or a similar incident. What follows is inevitable. She may become the object of any or all of the following assaults: punching with fists, choking, kicking, knifing, slamming against a wall, throwing to the floor, or shoving down the stairs. Sometimes even threats with a gun have been reported. When the beating is over, the couple move into the third phase. The batterer feels guilty about what he has done. He is sorry and may become loving towards her. He assures his wife that he will never do anything violent or hurtful to her again. At that moment, he may believe he will never hurt her again. She wants to believe him, hoping that he will change. However, even with professional help, the tension building and the beatings may continue

WHY DO WOMEN STAY?

Women have learned that it may be their own feelings of fear, guilt, or shame that keep them in a relationship that is physically abusive. Often, social and economic pressures compel a woman to stay. Sometimes she stays for lack of somewhere to go for shelter and advice or because she still feels that she loves her husband and that he might change, if only she can "hang in there." Tragically, in most cases, the abuse continues, for in fact her husband's behavior has nothing to do with her actions.

Other reasons for staying with him may seem as compelling. A woman may feel that a divorce is wrong and that she should keep her marriage together at all costs. Perhaps she feels her children need a father. She may be isolated with no outside job and few friends. The friends and relatives she does talk to may give her little support, perhaps because her situation frightens them and they don't want to admit to themselves that such violence could occur. If she confides in a counselor, she may also be encouraged to "save the marriage." And, along with her emotional dependence, she may worry about being able to find a job to support herself and her children. If she has her husband arrested, he may not be able to support her. If she doesn't have him arrested, he may beat her even more severely for trying to leave him. Is there a way out? Most women suffer these attacks for years before they finally find the courage and determination to take steps to keep from being victims of further abuse.

WHAT CAN A BATTERED WOMAN DO?

The first step for a woman to take is to admit to herself that she is being abused and that she is not being treated fairly. She has the right to feel safe from physical harm, especially in her own home.

Emergency Action

A woman can do a number of things to protect herself. She can hide extra money, car keys, and important do*****ents somewhere safe so that she can get to them in a hurry. The phone number of the police department should be handy. She should have a place to go, such as an emergency shelter, a social service agency, or the home of a trusted friend or relative.

During an actual attack, the woman should defend herself as best she can. As soon as she is able, she should call the police and get their names and badge numbers in case she needs a record of the attack. Most importantly, she should leave the house and take her children with her. She may need medical attention, too. Because she might be hurt more seriously than she realizes. Having a record or her injuries, including photographs, can protect her legally should she decide to press charges.

Long Range Plans

A woman needs to talk to people who can help. Good friends can lend support and guidance. Organizations that are devoted to women's concerns and not bound by society's traditions can assist her. They might help her explore her opinions in new ways. Emergency shelters for women, hotlines, women's organizations, social service agencies, community mental health centers, and hospital emergency rooms are all possible sources of support.

The following organizations have information about state contacts and shelters where a battered woman can go for help:

Center for Women Policy Studies 2000 P Street, N.W., #508 Washington, DC 20036 (202) 872-1770

National Coalition Against Domestic Violence 1728 N Street, N.W. Washington, DC 20036

Above all, a woman has to determine her own best course of action. Positive measures such as confiding in a relative, talking seriously with a friend, or consulting with a counselor are steps in the right direction. With the help of informal and formal help sources, including individual counseling for the husband as well as herself, a woman may be able to bring an end to the problem.

It has been observed that abused women need to develop better feelings about themselves - that is, change their self-image. In a book, "Stopping Wife Abuse," by Jennifer Baker Fleming, the following attitudes are suggested as positive and useful:

.I am not to blame for being beaten and abused. .I am not the cause of another's violent behavior. .I do not like it or want it. .I do not have to take it. .I am an important human being. .I am a worthwhile woman. .I deserve to be treated with respect. .I do have power over my own life. .I can use my power to take good care of myself. .I can decide for myself what is best for me. .I can make changes in my life if I want to. .I am not alone. I can ask others to help me. .I am worth working for and changing for. .I deserve to make my own life and happy.

PREVENTION

Since there is no one cause of wife abuse, there is no easy way to prevent it. Until society rejects its tolerance and acceptance of violence for resolving conflicts an expressing anger, meaningful changes in family relationships will not occur. Prevention starts with people changing their attitudes toward violence and women. No one deserves to be beaten or physically threatened, no matter what the excuse. It is a crime to beat anyone - a stranger, a friend, or your wife - and the law should be enforced. The tolerance of family violence as a way of life in one generation encourages family violence in another generation. Since the wife abuser didn't learn to deal with anger appropriately as a child, he handles his frustrations through aggression. He needs to know that it's human to feel anger, but inhuman to release those feelings by beating others. By learning to deal with these emotions through acceptable behavior, he can gain respect for himself and others. It's another positive step towards developing mutual respect in the husband/wife relationship where each sees the other as a worthy human being.

REFERENCES

Bowker, Lee H. WOMEN AND CRIME IN AMERICA, New York: Macmillan Publishing Co., Inc., 1981, Part II: pp. 234-328.

ABOUT WIFE ABUSE, South Deerfield, MA: Channing L. Bete Co., Inc., 1979.

Fleming, Jennifer Baker, STOPPING WIFE ABUSE: A GUIDE TO THE EMOTIONAL, PSYCHOLOGICAL, AND LEGAL IMPLICATIONS...FOR THE ABUSED WOMAN AND THOSE HELPING HER. New York: Anchor Press/ Doubleday, 1979.

Jaffe, Natalie. ASSAULTS ON WOMEN: RAPE AND WIFE-BEATING. New York: Public Affairs Committee, Inc. (Public Affairs Pamphlet No. 579).

Martin, Del. BATTERED WIVES. San Francisco: Glide Publication, 1976.

Straus, Murray A., Gelles, Richard J., and Steinmetz, Suzanne, BEHIND CLOSED DOORS: VIOLENCE IN THE AMERICAN FAMILY, New York: Anchor Books, 1980.

Walker, Lenore. THE BATTERED WOMAN. New York: Harper & Row, 1979.

This material was written by Lenore Gelb, staff writer, in consultation with NIMH scientists.

Department of Health & Human Services Public Health Service Alcohol, Drug Abuse, and Mental Health Administration 5600 Fishers Lane Rockville, MD 20857

DHHS Publication No. (ADM) 83-1265 Printed 1983

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