010-Psychiatric-Mental Health Nursing, 5th Edition-Sheila L. Videbeck-160547861X-Lippincott Willi

CHAPTER 11 • ABUSE AND VIOLENCE 183CLINICAL VIGNETTE: INTIMATE PARTNER VIOLENCEDarlene sat in the bathroom trying to regain her balance andholding a cold washcloth to her face. She looked in the mirrorand saw a large, red, swollen area around her eye and cheekwhere her husband, Frank, had hit her. They had been marriedfor only 6 months, and this was the second time that he hadgotten angry and struck her in the face before storming out ofthe house. Last time, he was so sorry the day after it happenedthat he brought her flowers and took her out to dinner to apologize.He said he loved her more than ever and felt terribleabout what had happened. He said it was because he had hadan argument with his boss over getting a raise and went outdrinking after work before coming home. He had promisednot to go out drink anymore and that it would never happenagain. For several weeks after he quit drinking, he was wonderful,and it felt like it was before they got married. She rememberedthinking that she must try harder to keep himhappy because she knew he really did love her.But during the past 2 weeks, he had been increasinglysilent and sullen, complaining about everything. He didn’tlike the dinners she cooked and said he wanted to go out toeat even though money was tight and their credit cardswere loaded with charges they couldn’t pay off. He begandrinking again. After a few hours of drinking tonight, heyelled at her and said she was the cause of all his moneyproblems. She tried to reason with him, but he hit her, andthis time he knocked her to the floor and her head hit thetable. She was really frightened now, but what should shedo? She couldn’t move out; she had no money of her ownand her job just didn’t pay enough to support her. Shouldshe go to her parents? She couldn’t tell them about whathappened because they never wanted her to marry Frank inthe first place. They would probably say, “We told you soand you didn’t listen. Now you married him and you’ll haveto deal with his problems.” She was too embarrassed to tellher friends, most of whom were “their” friends and hadnever seen this violent side of Frank. They probably wouldn’tbelieve her. What should she do? Her face and head werereally beginning to hurt now. “I’ll talk to him tomorrowwhen he is sober and tell him he must get some help for thedrinking problem. When he’s sober, he is reasonable andhe’ll see that this drinking is causing a big problem for ourmarriage,” she thought.An estimated 324,000 women experience violencewhile pregnant. Battering during pregnancy leads toadverse outcomes, such as miscarriage and stillbirth, aswell as to further physical and psychological problems forthe woman. The increase in violence often results from thepartner’s jealousy, possessiveness, insecurity, and lessenedphysical and emotional availability of the pregnant woman(Bacchus, Mezey, & Bewley, 2006).Domestic violence occurs in same-sex relationshipswith the same statistical frequency as in heterosexual relationshipsand affects 50,000 lesbian women and 500,000gay men each year. Although same-sex battering mirrorsheterosexual battering in prevalence, its victims receivefewer protections. Seven states define domestic violence ina way that excludes same-sex victims. Twenty-one otherstates have sodomy laws that designate sodomy (analintercourse) as a crime; thus, same-sex victims must firstconfess to the crime of sodomy to prove a domestic relationshipbetween partners. The same-sex batterer has anadditional weapon to use against the victim: the threat ofrevealing the partner’s homosexuality to friends, family,employers, or the community.Clinical PictureBecause abuse often is perpetrated by a husband against awife, that example is used in this section. These samepatterns are consistent, however, between partners whoare not married, between same-sex partners, and withwives who abuse their husbands.An abusive husband often believes his wife belongs tohim (like property) and becomes increasingly violent andabusive if she shows any sign of independence, such as gettinga job or threatening to leave. Typically, the abuser hasstrong feelings of inadequacy and low self-esteem as well aspoor problem-solving and social skills. He is emotionallyimmature, needy, irrationally jealous, and possessive. Hemay even be jealous of his wife’s attention to their own childrenor may beat both his children and his wife. By bullyingand physically punishing the family, the abuser often experiencesa sense of power and control, a feeling that eludeshim outside the home. Therefore, the violent behavioroften is rewarding and boosts his self-esteem.Dependency is the trait most commonly found inabused wives who stay with their husbands. Women oftencite personal and financial dependency as reasons whythey find leaving an abusive relationship extremely difficult.Regardless of the victim’s talents or abilities, she perceivesherself as unable to function without her husband.She too often suffers from low self-esteem and defines hersuccess as a person by her ability to remain loyal to hermarriage and “make it work.” Some women internalize thecriticism they receive and mistakenly believe they are toblame. Women also fear their abuser will kill them if they