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Pathologizing responses to violence?

Posted by DrChrisSOS on 10 Apr 2013 at 22:26 GMT

I received an email from an attorney who represents battered women in custody battles asking, with justifiable alarm, “Does this analysis prove that DV victims were mentally ill before they were abused?” Attached was Trevillion et al.’s Experiences of Domestic Violence and Mental Disorders. Attorneys representing domestic violence victims in contested custody cases often face arguments that their depressed, anxious, self-doubting, emotional, and scared clients (responding normally to manipulation, domination, physical and emotional abuse and the fear that the court may grant joint or primary custody to the abuser) confabulated or at least exaggerated the abuse, and are unfit parents because of their apparent “mental disorder.” The attorney feared that the literature review and meta-analysis could make her clients’ struggle to gain or retain primary custody under safe conditions more difficult.
The gist of my response to her concern was that the study does not “prove” anything because social science research only supports or does not support an hypothesis; that correlation is not causation; that the authors found valid data for lifetime domestic violence, not past year violence, raising the possibility of recall bias; and that they state, “Few longitudinal studies were found so the direction of causality could not be investigated.”
Yet the language used throughout the article suggests that mental disorder preceded the abuse. For example, the article states, “men with depressive disorders were more likely than men with no mental disorders to experience domestic violence.” Had they framed this correlation as “men who were abused were more likely to be depressed,” it would have suggested a different relationship between violence and at least this form of mental disorder. In fact, longitudinal data cited in the article indicated that depression and anxiety followed from abuse and these reactions were alleviated when exposure to violence ended.
Another problem is that abusers are not considered in the article. This absence allows the authors to suggest further research to assess whether interventions with victims reduce domestic violence. This solution could imply that control over the abuse lies with the victim. The article refers several times to “relationship violence.” It is not the relationship that is abusive. It is the other person. Victims, mentally disordered or not, are not the agents of the abuse. If the agency of the abuser were acknowledged when mental disorder preceded violence, one would have to explain whether (and why) abusers are likely to enter into romantic relationships with mentally disordered people or whether (and why) partners of mentally disordered people become abusive.
It is potentially damaging to victims of intimate partner violence that this article has been picked up by the popular press globally. Some of the titles of the secondary reports suggest that the study was interpreted as showing that mental disorder precedes – and invites – violence. Greater care in describing the data could have done less harm and more good.

No competing interests declared.