Transcript Violence Against Women: trauma and recovery

Throwing off the Burden of Shame:
Social Bonds and Recovery from the
Traumas of Gender-Based Violence
Judith Lewis Herman, M.D.
Pinel Liberating the Insane (1795)
Charcot at the Salpetriere (1887)
Women’s Liberation:
Consciousness-Raising (1969)
The Universality of Violence Against
Women
Violence against women is an obstacle
to the achievement of the objectives of
equality, development and peace. In all
societies, to a greater or lesser degree,
women and girls are subjected to
physical, sexual and psychological abuse
that cuts across lines of income, class and
culture.
--The United Nations Fourth World Conference on Women
Beijing, China - September 1995
Percent Women Certified by American
Board of Psychiatry and Neurology
Prevalence, Incidence, and Consequences of
Violence Against Women:
National Violence Against Women Survey
(Tjaden &Thoennes, 1998)
Total Rape
Women
Men
(N= 8000)
(N = 8000)
17.6%
3%
Lifetime Prevalence of PTSD
(Kessler et al, National Comorbidity Survey 1995)
Men
5.0%
Women
10.4%
Total
7.8%
Mental Health Impact of Gender-Based Violence
Australian Mental Health and Well-Being Survey, N=4451
(Rees, et. al, 2011)
Complex PTSD: The “A” Criterion
• Exposure to a traumatic event involving actual
or threatened death, serious injury, or threat
to physical integrity of the self or others,
producing intense fear, humiliation
helplessness or horror.
• This exposure is repeated over a period of
weeks, months or years.
Social Conditions Producing Prolonged and
Repeated Trauma
• The victim is under the control of the
perpetrator and unable to escape.
• The perpetrator uses an array of control
techniques, of which violence is only one.
• These techniques break down autonomy and
initiative and create a defiled and degraded
self-identity in the victim.
Coercive Techniques are Organized to Control
and Dominate Victim
Methods of Coercive Control
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Violence and Threat of Violence
Control of Bodily Functions
Capricious Enforcement of Petty Rules
Intermittent Rewards
Isolation
Degradation
Enforced Participation in Atrocities
---Source: Amnesty International Report on Torture, 1973
Rules for Relationships of Coercive Control
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The strong do as they please.
The weak submit.
Bystanders seem willfully blind or indifferent.
There is nowhere to turn for care or
protection.
Social Conditions Producing Prolonged and
Repeated Trauma
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Child abuse
Domestic violence
Some religious cults
Human trafficking and prostitution
Child soldiers
Slavery
Torture
Concentration Camps
Recruiting Women for Prostitution:
Professional Advice from a Pimp
“Beauty, yes. Sexual expertise, somewhat.
That can be taught easier
than you think. What is important above all is
obedience. And how do you get obedience?
You get women who have had sex with their
fathers, their uncles, their brothers---you
know, someone they love and fear and do not
dare to defy.”
---Richard Kluft, On the Apparent Invisibility of Incest. 1990
Impact of Coercive Control:
Complex PTSD
(Herman, 1992)
•Somatization
•Dissociation
•Affect dysregulation
•Shamed and defiled sense of self
•Disrupted relationships
•Shattered systems of meaning.
Shame as a Relational Experience
Shame is one’s own vicarious
experience of the other’s scorn. The self-inthe eyes-of-the-other is the focus of
awareness… The experience of shame often
occurs in the form of imagery, of looking or
being looked at. Shame may also be played
out as an internal colloquy, in which the
whole self is condemned.
--Helen Block Lewis, 1987
Suicide Attempts
(Dube et al, 2001)
N=17,337
35
30
25
20
Odds Ratio
15
10
5
0
0
1
2
3
4
5
Adverse Childhood Experiences
6
7+
Health Risk Behaviors
(Felitti et. al., ACE Study, 1998)
N=9,508
Childhood Trauma and Personality Disorder
(Herman, Perry, and van der Kolk, 1989)
N=74
Childhood
Trauma
NPD
SPD
.05
-.02
.25**
.48****
-.05
.15
.14
.40***
Witnessing
Violence
.10
.04
.21+
.35***
Total
Trauma
.06
.06
.32**
.54****
Physical
Abuse
Sexual Abuse
ASP
BPD
Implications for Treatment:
Antidotes to Coercive Control
Implications for Treatment: Avoiding Re-enactments
(Karpman’s Drama Triangle)
Rules for Relationships of Mutuality
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Everyone is entitled to respect
Everyone is entitled to a voice
Decisions are made by mutual consent
Power and responsibility are shared
Relationships are governed by principles of
fairness
Adaptive Strategies for Recovery
(Burgess & Holmstrom, 1979)
• Problem-Solving Action
• Affiliative Coping Style
• Mature Defenses: Altruism
and Humor
Treatment of Complex PTSD:
ISTSS Expert Clinician Survey
(Cloitre, et. al.: Journal of Traumatic Stress, 2011)
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Phase-Based or Sequenced Psychotherapy
Initial Focus on Trauma Education
Anxiety/Stress Management
Emotion-Regulation Strategies
Interpersonal Skills
Narration of Trauma Memory
Cognitive Restructuring
The Analysis of Shame
Adopting the viewpoint that shame is a normal
state which accompanies the breaking of affectional
bonds allows shame to take its place as a universal,
normal human state of being. Analyzing shame
reactions in an atmosphere in which their natural
function is taken for granted makes analytic work
considerably easier… Perhaps the greatest
therapeutic advantage of viewing shame and guilt as
affectional bond controls is the emphasis placed on
the patients’ efforts to restore their lost attachments.
----- Helen Block Lewis (1981)
Resolution of Shame in Groups
People have at once a sense of their own honour
and a respect for other people’s honour; they can
feel indignation or other forms of anger when
honour is violated, in their own case or someone
else’s. These are shared sentiments, and they serve
to bind people together in a community of feeling.
----Bernard Williams
Shame and Necessity, 1993
Response to Gender-Based Violence:
35 Years of Feminist Organizing
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Public Education
Hotlines
Victim Support Groups
Shelters and Rape Crisis Centers
Victim Advocacy
Research & Professional Education
Police Training
Restraining Orders and other Legal Reforms
Restitution: Victims of Crime Act (1984)
Community Accountability
Accountability for Perpetrators
On the Occasion of International Women's Day
"Women and men united to end violence against women and girls”
------Yakin Ertürk, Special Rapporteur on Violence against Women, 2009
The UN mandate for the elimination of
violence against women… reflects the demands,
interests and aspirations of women in all parts of
the world… It is now firmly acknowledged around
the world that violence against women is not an
inevitable fate, nor can it be justified or excused by
any means. It has also given hope to women in all
corners of the world that this pandemic can and
must be stopped.