- Email: [email protected]
Domestic violence—An emerging health issue
Pergamon
DOMESTIC
Ser. Sci. Med. Vol. 39, No. 9, pp. 1181-IIR8, 1994 Elsevier ScienceLtd. Printed in Great Bntain
0277-9536(94)00201-O
VIOLENCE-AN
EMERGING
HEALTH
ISSUE
ANA LIA KORNBLIT lnstituto
de Investigaciones
de la Facultad de Ciencias Sociales de la Universidad Moldes 1243, 1426 Buenos Aires, Argentina
de Buenos
Aires,
Abstract-The aim of this paper is to explain some of the aspects included in the concept of family violence, to summarize the principal theoretical models proposed to explain it, as well as to describe the principal syndromes included within the scope of the concept: battered woman, courtship violence, child-abuse, child sexual-abuse, child witnessing violence, sibling violence and elderly violence. Particular emphasis is put on the description of the effects that different types of family violence cause on the individuals’ health.
Kq
Icsords-family
violence,
child-abuse,
battered
Social representations about the family endow it with characteristics linked to affectivity and support among its members. Although these functions are socially adjudged to the family and many fulfil them, it is evident that, frequently, families are also the scene of violent human relationship expressions, both between the couple and among parents and their offspring. Although family violence has existed since immemorial times as shown, for example, by historical studies about children and women, its present day visibility is linked to the women’s new social status and with the child’s consideration as a subject of rights. Violence is indissolubly linked to the exercise of power and, in the Western world, the questioning of the ancient right of the pater familiae’s right to dispose of his wife and offspring, now replaced by the State’s duty to watch over the observance of the citizen’s human rights, has begun to pull off the veil of family privacy over situations that attempt against its members’ physical and psychic integrity. It is within this context that we can explain why only since 197Gand specially in the United States and in Great Britain-family violence began to be recognized as a social problem. Consequently, there was a great development of the field at the academic level. Regarding child abuse, it was not until the 1950s that the medical community began to note that many children were intentionally harmed by their parents. In spite of the great amount of work done on the subject, all researchers note the absence of valid statistics about the problem, taking into account the fact of underreporting. Prevalence data indicate that nearly 30% of all
women,
child sexual-abuse
couples report experiencing at least one violent episode during their marriages [I]. However, due to underreporting, these figures probably underestimate the problem. It has been suggested that physi‘cal abuse is closer to 50&60% [2]. Family violence rates are somewhat lower for middle class family groups, but they are not lower enough to support the widely held view that this form of violence is found only in the lowest socioeconomic groups. The approximation to this field makes it necessary to explain some of the aspects included in the concept of family violence. A common distinction is made between ‘abuse’ and ‘violence’. The former refers to actions which are harmful for the victim, both physically as well as mentally, committed or resulting from omission, carried out either intentionally or not. Violence in a limited sense is used to refer to physical aggression. Maltreatment includes abuse (physical, sexual and/or emotional) and neglect (physical, educational and/or affective). Abuse indicators have been classified as: physical symptoms, illnesses (relapses of infectious-contagious diseases); illnesses with psychic sources; psychic symptoms and social inadequateness symptoms. In general terms, nowadays the definition of family violence includes the following elements:
(1) action or omission of behaviours
which result on damage produced within the family scope to members of the group; (2) intentionality; (3) negative incidence on the individual’s phisical or psychic development;
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ANA LIA KORNBLIT
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(4) negative incidence on the subject’s perception about himself/herself; incidence on subject’s physical (5) negative and/or psychic health. It has been said that violence in two senses:
there
is a cycle of family
(1) Strauss
(‘I trl. [3] assert that children or youths who witnessed violence or who experienced it passively will repeat it actively when adults. Within this model, violence as a conflict-resolving instrument is learnt by some children as part of their socialization. The authors suggest a snowball effect, with family socialization through violence leading to high rates of different forms of violence within the family. (3) Walker [4] has described a cycle of family violence characterized by three phases: (I) tension accumulation; (2) explosion or acute phase of blows: (3) ‘honey moon’ or loving calm. After a variable space of time. the first phase begins again, inasmuch as the system’s perpetuating conditions are not changed. As Grosman 1’1 ~1. [5] say. we can sum up some assumptions regarding the onset of family violence as follows: (1) Family violence is positively related to authoritarian family systems. which ‘naturalire‘ it (make it appear as a common fact of everyday life): (2) the more rigid the family system hierarchies arc. the more serious may violent expressions within the family be: (3) the more rigid the family interactions are. the more serious may violent expressions within the family be: (4) family members’ autonomous life is inversely related to the intensity of violence; to (5) the greater family members’ adhesion cultural stereotypes about the family and to gender stereotypes, the more serious may violent expressions within the family be; (6) the purpose of the weaker family members of ‘running away’ from stereotypes about family relationships and from gender stereotypes may trigger off violence within the family; (7) a greater interaction with the outside world promotes a ‘denaturalization’ of violent behaviours within the family; (8) a greater interaction with the outside world promotes the denouncement of violent behaviours within the family. EXPLANATORY
MODELS ABOUT FAMILY VIOLENCE
At the beginning explanatory models intrapersonal models
of research on this subject, about family violence were focused on medical variables.
Gradually, these models were replaced by broader points of view focused on sociopsychological variables. We will summarize some of the models proposed to explain family violence: (I) Intrapersonal models underline that violence is originated on the subject’s psychological abnormalities. Thus, profiles of the ‘batterer husband’ or of parents responsible for children abuse were outlined [6]. For instance, Wetzel and Ross [7] proposed a profile of men who batter that included the following features: partner’s jealousy; partner’s control and isolation; Jekill and Hyde personality; explosive temper; legal problems; projection; verbal as well as physical abuse; history of family violence; more violent when partner is pregnant or soon after she gives birth; denial and cycle of violence and contrition. The same authors characterized battered women as follows: she accepts traditional sex roles; she accepts malt dominance and the myth of male superiority; she equates dominance with masculinity; she accepts ‘partner’s reality’; the feelings about her own worth arc based on her ability to ‘catch’ and hold a man; she suffers from a low self-esteem. (2) In world literature the sociostructural model is the most widely applied one. This approach emphasizes social structures, norms and values as causal variables in the process of family violence. In many of these studies, maltreatment is seen as arising from changes in traditional ways of life. Researchers who use this model have focused on the changing demands placed on the family by society, creating unreasonable demands on it [8]. (3) The social learning approach emphasizes the influence of variables such as occupational status and parental modelling on the onset of violence. A study by Howell and Pugliesi [9] particularly states that an unsatisfactory employment status strongly increased the likelihood of violence in younger subjects (aged ~40 years). Older subjects (aged ~40 years) could endure several strains simultaneously. Barling and Rosenbaum [IO] also found that, in general terms, stressing work experiences were significantly associated with wife abuse. (4) Sex role socialization has been strongly associated with family violence, through stereotypes of both genders, devaluation for women’s work inside and outside the home and socially condoned family violence. Findings stress the importance of analysis of the family as a locus of struggle, pointing to gender and age structuring as a source of power differences. Within this model, the domination-submission relationship is at the ground level of violence, and the perpetuation of family violence is showing that the hierarchical model is still at the basis of social functioning.
Domestic violence-an Carroll [ 1 I] found that the transmission of violence was more likely to occur within same sex-linkages. Women’s work and independence seem to be the structured conditions for change of the couple’s relationship, but transition towards more egalitarian forms of relationship may generate tensions that result in greater possibilities of violent events within the family. As Bremes and Gordon [I21 assert from this point of view, violence is not random and haphazard. A gender and generational understanding of family violence requires that the analyses focus on who is violent to whom, how violence is expressed, and what its effects are. In this way, patterns will emerge more clearly than visualized at this moment. (5) The frustration-aggression hypothesis has been also widely applied to family violence, based on the idea that, in this realm, it appears as a deviation from the public world to the private one, rendered possible by the standing of its tolerance within the latter. Berkowitz’s [ 131 review reformulates Dollard’s [ 141 hypothesis of frustration-aggression. taking into account that a frustration capable of evoking aggression must involve the non-attainment of an expected reward. rather than a mere deprivation. In this sense. the implied frustration could be that the subject is unable to reach his expectations about family members. (6) During the last few years, attention has been set on the importance of causal attributions in the couples’ dysfunctional relationships [ 151. A large proportion of couples attribute their negative behaviours to internal causes, thus underlying the negative impact of these behaviours. The results of researchers carried out along this line point out that couples with problems assign causal and responsibility attributions that minimize the impact of their mate’s positive behaviour and maximize the negative one. Self-blame described about battered women is an example of these attributional patterns that seem to be distinctive in violent relationships. Research on the attributions made by victims of crimes suggest that they tend to blame themselves for their victimization [ 161. Theories of self-blame developed from victims of assault and robbery have been applied to studies of battered women, to better understand their perception of the causes of their victimization. It is said that self-blame restores the victims’ control over the environment, so that a positive adjustment in those circumstances may be possible. However, self-blame may not be a functional coping mechanism to avoid future abuse. On the other hand, the study of attributions made on close relationships can influence clinic work, since therapy may contribute to the couple making milder attributions both towards themselves and towards their mates. (7) Another explanatory model is the one proposed
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by social constructivism [17], for which it is impossible to differentiate between facts and values in social life. Attitudes, expectations, sanctions and demands from the social context over the family have a great importance in violent behaviours. This model points out that couple violence is not only the result of a transaction between a man and a woman, but that it emerges from past, present and future interactions of individuals related to the social context. (8) On the other hand, the systems theory points out that the victim-victimizer scheme, as a description of family violence, escapes from family consideration as a system in which interactions take place as a consequence of each other, in positive or negative feedback flows. Researchers who work with this model take into account the couple system, the nuclear family system, the extensive family system, as well as the therapist-family system, when there is therapeutical intervention.
DESCRIPTION
OF CLASSICAL
FAMILY
VIOLENCE
SYNDROMES
The impact of violence in the family goes well beyond its immediate effects on victims and assaulters. It creates irreparable damages to the entire family. Nevertheless, it is possible to describe the following distinctive syndromes: I Battcwd
women
The characteristic is the husband’s repeated physical aggression to his wife. It is interesting to notice that the expression ‘battered man’ does not appear in literature, the cases of violence experienced by men from women being reduced to isolated behaviours, not to reiterative ones. The fact that attacks are repeated and that blows are multiple constitute the battering. Regarding the dynamics of violence in marriage, it has been said that the problem of violence begins when a man with low frustration tolerance is paired with a highly provocative woman [18]. Besides, many women report the feeling of tension before violence, but they don’t know how to stop it. The syndrome has been assimilated to posttraumatic stress. Its main features appear to be anxiety-related symptoms in response to stressors, evidenced as physical or psychological problems. Since it is known that trauma produces stress related symptoms, it is likely that battered women will evidence physical or psychological problems along time. They also reported a significantly higher level of somatic complaints [19]. Follinstad et al. [20] think that the inability to predict the moment when abuse will take place results in more anxiety symptoms for these women. Women with very severe symptoms also have little
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ASA LIA KORNBLIT
social support. Consequently, they are not protected by the stress buffer function. Lowered self-esteem and more severe depressive symptoms were found in women with minimal personal resources, lack of institutional and informal social support and greater avoidant coping styles [2]. Therefore, stress and personal resources have indirect effects on functioning, through their impact on coping responses and the non availability of social support [22]. Results from regression analysis indicate that selfesteem contribute as a more unique variance to physical aggression than depressive symptomatology. Continued and repeated physical abuse seems to have a more lasting and dramatic effect on the self-esteem of these women than on their depressive symptomatology [23]. Women who experienced more types of emotional abuse showed more physical and psychological symptoms. Thus, as Follinstad et al. [20] express, the experience of emotional abuse is a possible reason for an early deterioration of health. The effects of a decline in physical health persist to some extent even when abuse ceases. Seligman’s [24] concept of ‘Icarned helplessness’ as a state characterized by a sense of the impossibility of reaching goals from ones’ own behaviour is consistent with the description of the battered woman’s syndrome. Although marital rape is not necessarily an aspect of all battering relationships. violent sex separated from other forms of violence is rare. There are few studies on this subject. Particular emphasis has been put on the reasons that keep battered woman captive [7]: financial dependence, fear and family and religious values were mentioned as the main features. Other features recognized were: lack of admission of marriage failure, self-blame and marriage worth above everything. Understanding the decision to leave an abusive relationship is central for theoretical and practical purposes. It has been said [25] that the decision to leave or remain in an abusive relationship is a ‘rational’ decision, though the outcome may be considered abnormal by normative standards. The process has been studied from the point of view of four theoretical models: (I) Psyhologicul entrapment, which is described as “a decision process whereby individuals escalate their commitment to a previously chosen though failing course of action in order to justify prior investments” [26. p. 51. In other words. entrapped individuals think they have “too much invested to quit” [22]. The more time and effort the woman invests, the harder it becomes to give out without success and the less likely that a battered woman will leave the relationship [29]. (2) Learned helplessness. Walker [4] suggested that battered women can be characterized as exhibiting
learned helplessness, a syndrome coined by Seligman [24] to describe a perceived non-contingency between responses and outcomes, that gives rise to the expectation that future responses and outcomes will also be independent. On a descriptive level, the learned helplessness model provides a compelling account of the battered woman syndrome: the continued abuse despite efforts to make the relationship function communicates a lack of contingency between responses and outcomes. (3) Relative costs and bemfits. A third model that can be used to examine decisions to leave abusive relationships derives from the exchange theory, which is based on the premise that such a decision follows from a cost and benefit analysis of current relationships, compared to alternative ones. This cost-benefit analysis [29] is useful in identifying multiple responses to abusive relationships. . (4) The theory qf reasoned action. Proposed by Fishbein and Ajzen [30], it holds that thoughtful actions and decisions are directly related to behavioral intentions. These are in turn determined by: (a) the attitude toward that behaviour; and (b) the subjective norm. According to this model, a woman may not intend to leave an abusive relationship because her beliefs about the consequences of that action underestimate or overestimate the real probabilities. For example, women may doubt that abuse will really end if they leave, or they may think it unlikely that they can gain financial independence. Or they may not dare to leave because they think their social network will not approve their behaviour. A second problem could be a high motivation to comply with those who believe they should stay. This model provides a potentially invaluable aid for intervention. Altering unrealistic evaluations calls for interventions that educate and inform to change the perceived desirability of the consequences of Icaving. As Strube [25] says, although a fair amount of knowledge has been accumulated regarding relationship decisions, our understanding of the dynamics of this decision process is still weak. Each one of the described models provides a perspective for viewing relationship decision, but future research should examine the ways in which they can be integrated to improve their predictive power, so as to “spare many women needless and senseless suffering” (p. 248), -3. Courtship uiolence One of the aspects that has been studied about family violence repetition is the violence exerted during courtship. A study developed by Smith and Williams [31] showed that students who had been abused by their parents accepted anger as a ‘natural’ feature of human relationships and abused their dates, using I I out of 13 types of violence presented by the researchers.
Domestic violence-an Several forms of violence shown by the results of the study were painful and sophisticated, indicating that they were part of a repertoire of action as well as premeditated. It is assumed that most of these forms of violent dating were learned within an abusive household. But we still need a research that will explain why so many youngsters who are involved in violence when dating come from households where there is no violence. At the same time, a significant number of surveyed youngsters who had been abused by their parents ended a dating relationship because of a display of violence. But also, a more significant number of abused respondents indicated that they continued to date a person who acted violently towards them. These findings question why, under certain circumstances, the violent model learnt by the subject from his/her own family can work as a stimulus to search for other types of bonding, withdrawing from repetition, and why, under other circumstances, it works as a model that the subject repeats with his/her own couple and family. New researchers on this subject could explain some important questions about the onset of family violence. 3. Child abuse In 1962 Henry Kempe published an article [32] in which they described the “battered-child syndrome”, resulting from harmful actions by parents or foster parents. Lately, in 1970, David Gil [33] proposed a broader definition of child abuse which included neglect. The concept comprises, according to Gulotta [32]: (a) (b) (c) (d) (e)
physical aggression; sexual disturbance and violence; neglect related to health and protection; physical forlornness; emotional forlornness.
The diversity of child maltreatment suggests some cultural factors and values associated with child abuse [38]. As described in the medical literature, the clinical signs of the battered child syndrome include bruises, welts, lacerations, abdominal injuries, ocular damage, burns and bone fractures. The syndrome called ‘failure to thrive’ has been associated with the neglect of children. Here, children fall below the third percentile for weight and height, with slowed neurological and psychological growth, and with no signs of organic illness to account for the deficiencies. The syndrome has been described in families in which mothers cannot fulfil their children’s emotional and nutritional needs.
emerging health issue
1185
Physical abuse is most often associated with oppositional child behaviours, whereas neglect is characterized by adult failure to assume basic responsibilities on behalf of the child. Therefore, the neglecting parent may show a more chronic pattern of interpersonal conflict and apathy than the abusive parent [36]. One of the effects of child abuse is the impairment of socioemotional and cognitive development [37]. On the cognitive developmental level, the abused child is frequently placed below half of his intellectual and linguistic competence. On the socioemotional developmental level, a pattern of avoidance, withdrawal or coolness, as a sequel of either physical or psychical maltreatment has been described for the abused child. The child abuse sociocognitive profile includes little confidence on his/her powers to influence on events or their modification, and the attribution of their control to external factors. It has been also said that there is a relationship between the lack of inner control perception and a low self-esteem, with difficulties to prevent events and over watchfulness. In terms of Piaget’s [38] model, we can find an extended pre-operational stage in cognitive development in these children, along with cognitive egocentrism and with difficulties in recognizing the others’ perspective. This last point is considered as a preceding element of empathy, and its weakness can also explain the over watchfulness and distrust showed by abused children, since it hinders the evaluation of the feelings and behaviour goals of the others [37]. However, other research results [39], suggest that the deficits in cognitive functioning apparent in abused children are no more pervasive than those found in children from low socioeconomic backgrounds. Thus, it may be that depressed family circumstances common in violent families, and not maltreatment per se, are responsible for the cognitive deficits often noted in abused children. Stressful events than can not be controlled, present in those environments, deny children the sense of mastery that might encourage learning. Moreover, as Herrenkohl [40] conclude, the parents’ deficient coping skills are transmitted to the child via: (a) modelling of inadequate coping strategies; (b) inadequate provision of an encouraging and supportive environment; (c) a locking of parent and child into a vicious circle of negative reinforcement. Weissman-Wind and Silver [41] explore whether child abuse constitutes a generic risk to survivors’ adult adjustment, or whether, instead, physical, sexual or combined abuse has specific, differential adult correlates.
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ANA LIA KORFCBLIT
The findings suggest a highly generalized response to abuse, regardless of its specific sexual or physical nature. These results fortify the trauma model hypothesis, taking into account that the combination of sexual abuse and physical maltreatment appears to be as detrimental as the severest forms of sexual or physical abuse. The major debate with respect to child abuse relates to whether or not it represents a phenomenon distinct from general maltreatment of children, and whether special programmes are needed to face it. It seems that there arc variations within a continuum of severity of maltreatment. In developed countries the movement seems to be one of improving care for all children, rather than developing specialized programmes. However. in Third World countries. children at risk may be the target for particular programmes, as basic needs arc not fulfilled for large groups. As Gellcs and Cornell [8] stated. a major concern in a Third World definition of abuse is the impaired development of children or even death resulting from adverse environmental conditions that could be prevented by way of adequate health scrviccs. ‘Nutritionally battered child’ is a term coined to include prolonged protein malnutrition which includes pre-kwashiorkor and recurrent kwashiorkormarasmus syndromes.
EXPLANATORY
MODELS ABOCIT CHILD-ABLSE
The initial conceptualization of abusive parents assigned primacy to cognitive, affective and motivational factors in the adult and a lesser importance to contemporaneous variables. Case studies have addressed hypothesis rclatcd to early childhood experiences and personality profiles of abusive parents to support the idea that parental psychopathology is responsible for child abuse. In general terms. the studies that use measures of underlying personality attributes or traits have been unable to detect any patterns associated with child abuse. beyond general descriptions of displeasure in the parenting role.
Bowlby’s [42] model about the importance of the relationship with the bonding figure and the predictive capacity of the quality of this first regarding later maltreatment has relationship constituted the framework for many studies on child abuse. However, the concept of bonding may be culturally tinged and it may be of limited usefulness in a cross-cultural comparison. For instance, there is apparently no child abuse in cultures where separation of mother and child takes place during an early phase.
This model relates child abuse with situational events which exert an influence on parental competencc. These studies analyse psychological processes such as cognitive skills. family roles. expectations and child related experiences. all of which could lead to defined competence differences in situationally among parents [43]. These findings guide prevention efforts at reducing situational demands and at developing learned experiences for abusive parents, rather than sending them to a psychiatric unit.
This model represents a contrasting viewpoint of child abuse that puts emphasis on antecedent events that may prccipitatc and maintain child abuse, as well as on interactional patterns within the family [44]. Within this context. the target child is viewed as an active participant in an escalating cycle of coercion [451. It is considcrcd that child aversive behaviour and ;I stressed environment precipitate conditions that interact with parental competence. In this connection, child abuse is considered as an attempt made by the parents to gain control over multiple environmental avcrsivc cvcnts. Socictics where physical punishment techniques are infrequent arc societies with extended family houscholds who are alternative caretakers in the household and share child rearing responsibilities. This fact would support the hypothesis about the origin ol tension on the parents -offspring relationship. based on demands which parents are not capable of answcring.
CHII.1) SEXUAL
ABUSE
According to Browne and Finkelhor [46] child sexual abuse consists of two overlapping but distinguishablc types of interaction: (a) Forced or coerced sexual behaviour imposed on a child; and (b) sexual activity between a child and a much older person, whether or not coercion is involved. There is a lack of evidence for common symptoms in children who have been sexually abused; on the these children manifest a variety of contrary. symptoms [47]. Nevertheless. Corwin [48], Wolfe et ul. [49] and other authors mention that sexualized behaviour and post-traumatic stress disorders frequently occurred in these cases. The post-traumatic stress disprder results from experiences that arc overwhelming. sudden and dangerous [50]. Finkelhor and Rosenbaum [51] suggest that sexual
Domestic violence-an abuse traumatize children types of mechanisms: (1) (2) (3) (4)
through
four distinctive
traumatic sexualization; betrayal; stigmatization; powerlessness.
In spite of this, there are few theoretical advances about what causes the children to be symptomatic. Two types of effects of sexual abuse can be distinguishable: (a) Short term Qkts, which are early reactions produced within two years of the termination of abuse, and include reactions of fear, anxiety, depression, anger and hostility, as well as inappropriate sexual behaviour. (b) Long term efects, with depression as the symptom most commonly reported among adults who suffered sexual abuse as children. Self-destructive behaviour, anxiety, feelings of isolation, poor self-esteem, a tendency toward revictimization, difficulty in trusting others and sexual maladjustment have also been recorded by other researchers. In general terms, there is no factor on which all studies agree as being associated with a worse prognosis, though the victim’s non-supporting families could contribute to a worse evolution.
VIOLENCE
WITNESSING
CHILDREN
Both marital violence and non violent marital discord were found to be related to behavioural and emotional problems in witnessing children [52]. The research carried out by these authors showed that exposure to marital discord or marital violence had a greater generalized effect on children’s emotional health than a punitive parenting style, which was related more specifically to behavioral disorders. This research refutes the behaviour modelling character of family violence experiences lived passively,
though
its lasting
effects
on
personality
are
shown. Hinchey and Gavehck [53] found that the early and pervasive influence that marital discord may have on young children is expressed by an impairment of their empathic abilities, measured through four scales: role enactment. social inference, role taking and social behaviour.
SIBLING
VIOLENCE
The effect of violent experiences with siblings should be given a greater consideration than it has been given in literature. A study developed by Gully [54] showed that this type of family violence was a significant predictor of self-reported violence and of self-predicted violence in hypothetical situations.
1187
emerging health issue ELDERLY
ABUSE
Elderly victims of abuse are not visualized as clearly as other members of the family. For instance, community resources for both the elderly abused and their abusers are lacking [55]. Both sibling violence and elderly abuse should be studied more deeply and should be the object of research and of community programmes focused on these subjects. EPILOGUE
Resort to violence in family relationships implies a failure of language as an instrument of human understanding. Consequently, family violence implies the existence among the members of the group of weak communication skills, which are summed up to an equilibrium breakdown when one of them attempts a ‘running away’ from family cultural stereotypes and/or from gender stereotypes. Since it is supposed that this ‘running’ will be reached through a long process towards more egalitarian relationships-that have only began in some places-, it is possible that prevention should centre on the improvement of communication skills within the family, as a way of endowing people who suffer strong pressures originated in individual, social and cultural tensions, with better resources to cope with them. School should not be away from this purpose. REFERENCES
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Be/w/or:
A/r I///rr~dr/c/irm
/o 7heor~
mu/ Rc.vcwr~~//.
Addison-Wesley. Boston. 1975. Smith J. P. and Wilhams J. I’rom ahusivc household to dating violence. J. I;cr/~ri/.~,1_iol<,/r(r 7, 153. 1992. Kcmpe C. H. The battered child syndrome. .I :I,JI. .tf(,(/. .-l.\\or,. 8, 17. 1967. Gil D. 1‘i&//cc .A,yrrit/.s/ Chtldw//: I’//~.\iul Child Ahusc it1 l//l’ i :ni/cYl S/t//c,.\. Harvard C!nivcrsity Press, C‘ambrldgr. 1970. Gulotta G. Fmri,y/iu ~2r~/~&~tr. Giulr‘rt:. Milin 1984. Grossman C. > Mcstcrman S. :\lol/rrr/o 01 mwor. El I~rdo
de la escen~ ,/amiliur. Editorial Universitaria. Buenos Aires, 1992. 36 Wolfe D. Child abusive parents: an empirical review and analysis. In Psycho/. Bull. 97, 462. 1985. 37 Ortiz Bar6n M. J. Consecuencias de 10s males tratos en cl desarrollo socio-emotional y cognitive. In Los m&s 0’uo.v J‘ rl ahandono in/&/i/ (Edited by J. de Paul Ochotorena). VI Curses de Verano de San SebastiLn. Universidad del Pais Vasco. 1990. 38 Piaget J. The Moral Jud,.wwt/r of/he Child. Kegan Paul. Londres, 1932. N. N. and Walker F. F. The impact of 39 Nightingale social class and parental maltreatment on the cognitive functioning of children. J. Futni/F Violence 6, I 15, I99 I. E. C., Herrenkohl R. C.. Toedfer L. and 40 Herrenkohl Yanushefski A. Parent-child interactions in abusive and nonabusive families. J. Am. Acad. C.&/d P.rychirr/. 23, owl/o
641. 1984.
41
Weissman-Wind T. and Silvern L. Type and extent of child abuse as predictors of adult functioning. J. Frmu~~~ k’iokvw 7, 261, 1992. 42. Bowlby J. .4//ucl1men/ u//d Los.v. Vol 3. Los.v, Stidwss t/r/d Dcpres.sion. Hogarth Press, London: 1980. 43. Wolff P. H. Mother-infant interactions in the first year. /‘iebt, Engl. J. Med. 295, 999, 1976. 44. Burgess R. L. and Richardson R. A. Coercive interpersonal contingencies as determinants of child abuse: Implications for treatment and prevention. In Behal,iorrrl
45. 46. 47.
48.
49.
50.
51.
52.
53.
54.
55.
Pww//
TwininK:
I.wues in Research
und Prucrrcc,
(Edited by Dangel R. F. and Polster R. A.). nn. 239 259. Guilford. New York. 1984. batterson G. R. Coewiw Fami!,, Prows.v. Castalia, Eugene. OR. 1982. Browne A. and Finkelhor D. The impact ofchild abuse: a review of the research. P.uj,chol. Bull. 99, 66, 1986. Kendall-Tackett H., Meyer Williams L. and Finkelhor D. Impact of sexual abuse on children: a review and synthesis of recent empirical studies. P.c,t~ho/. B/r//. 113, 164, 1993. Corwin D. Early diagnosis of child sexual abuse: diminlshing the lasting effects. In Lasting Efflc/.r of’ Child St\-ual Abuse (Edited by Wyat G. E. and Powel G.), pp. 251 270. Sage. Newhury Park, CA, 1989. Wolfe Y. V.. Gentile C. and Wolfe D. A. The impact of sexual abuse on children: a PTSD formulation. B&/t,. T/w. 20, 21 5, 1989. Figgley R. Trcnmw u//d i/x Wukc Vol. II. ~Traumcrtk Strtw Theor),, Rrseurcl/ r/ml Inrerrcnrron. Brunner! Mazel. New York, 1986. Finkelhorn M. and Rosenbaum A. The traumatic impact of child sexual abuse: a conceptualization .4m. .I. Or/ops,t~chio/. 55, 530. 1985. Hershorn M. and Rosenbaum A. Children of marital violence: a closer look at the unintended victims. AM. .I. Or/op.v,&itr/. 55, 260, 1985. Hinchey F. and Gavelick J. Empatic responding in children of battered mothers. Child .Ahrrse Nrykt 6, 395. 19x2. Gully K., Dengerlnk H.. Pepping M. and Bergstrom D. Research note: sibling contribution to violent behavior. ./. ,2ftrrr/tqr Firnrih~ 43, 333. 19XI Chen Pen N. Elderly abuse in domestic settings: a pilot htudq. J G‘c,rrjn/ol %c~. Work 4, 3, I98 I.
DOMESTIC
Ser. Sci. Med. Vol. 39, No. 9, pp. 1181-IIR8, 1994 Elsevier ScienceLtd. Printed in Great Bntain
0277-9536(94)00201-O
VIOLENCE-AN
EMERGING
HEALTH
ISSUE
ANA LIA KORNBLIT lnstituto
de Investigaciones
de la Facultad de Ciencias Sociales de la Universidad Moldes 1243, 1426 Buenos Aires, Argentina
de Buenos
Aires,
Abstract-The aim of this paper is to explain some of the aspects included in the concept of family violence, to summarize the principal theoretical models proposed to explain it, as well as to describe the principal syndromes included within the scope of the concept: battered woman, courtship violence, child-abuse, child sexual-abuse, child witnessing violence, sibling violence and elderly violence. Particular emphasis is put on the description of the effects that different types of family violence cause on the individuals’ health.
Kq
Icsords-family
violence,
child-abuse,
battered
Social representations about the family endow it with characteristics linked to affectivity and support among its members. Although these functions are socially adjudged to the family and many fulfil them, it is evident that, frequently, families are also the scene of violent human relationship expressions, both between the couple and among parents and their offspring. Although family violence has existed since immemorial times as shown, for example, by historical studies about children and women, its present day visibility is linked to the women’s new social status and with the child’s consideration as a subject of rights. Violence is indissolubly linked to the exercise of power and, in the Western world, the questioning of the ancient right of the pater familiae’s right to dispose of his wife and offspring, now replaced by the State’s duty to watch over the observance of the citizen’s human rights, has begun to pull off the veil of family privacy over situations that attempt against its members’ physical and psychic integrity. It is within this context that we can explain why only since 197Gand specially in the United States and in Great Britain-family violence began to be recognized as a social problem. Consequently, there was a great development of the field at the academic level. Regarding child abuse, it was not until the 1950s that the medical community began to note that many children were intentionally harmed by their parents. In spite of the great amount of work done on the subject, all researchers note the absence of valid statistics about the problem, taking into account the fact of underreporting. Prevalence data indicate that nearly 30% of all
women,
child sexual-abuse
couples report experiencing at least one violent episode during their marriages [I]. However, due to underreporting, these figures probably underestimate the problem. It has been suggested that physi‘cal abuse is closer to 50&60% [2]. Family violence rates are somewhat lower for middle class family groups, but they are not lower enough to support the widely held view that this form of violence is found only in the lowest socioeconomic groups. The approximation to this field makes it necessary to explain some of the aspects included in the concept of family violence. A common distinction is made between ‘abuse’ and ‘violence’. The former refers to actions which are harmful for the victim, both physically as well as mentally, committed or resulting from omission, carried out either intentionally or not. Violence in a limited sense is used to refer to physical aggression. Maltreatment includes abuse (physical, sexual and/or emotional) and neglect (physical, educational and/or affective). Abuse indicators have been classified as: physical symptoms, illnesses (relapses of infectious-contagious diseases); illnesses with psychic sources; psychic symptoms and social inadequateness symptoms. In general terms, nowadays the definition of family violence includes the following elements:
(1) action or omission of behaviours
which result on damage produced within the family scope to members of the group; (2) intentionality; (3) negative incidence on the individual’s phisical or psychic development;
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ANA LIA KORNBLIT
1182
(4) negative incidence on the subject’s perception about himself/herself; incidence on subject’s physical (5) negative and/or psychic health. It has been said that violence in two senses:
there
is a cycle of family
(1) Strauss
(‘I trl. [3] assert that children or youths who witnessed violence or who experienced it passively will repeat it actively when adults. Within this model, violence as a conflict-resolving instrument is learnt by some children as part of their socialization. The authors suggest a snowball effect, with family socialization through violence leading to high rates of different forms of violence within the family. (3) Walker [4] has described a cycle of family violence characterized by three phases: (I) tension accumulation; (2) explosion or acute phase of blows: (3) ‘honey moon’ or loving calm. After a variable space of time. the first phase begins again, inasmuch as the system’s perpetuating conditions are not changed. As Grosman 1’1 ~1. [5] say. we can sum up some assumptions regarding the onset of family violence as follows: (1) Family violence is positively related to authoritarian family systems. which ‘naturalire‘ it (make it appear as a common fact of everyday life): (2) the more rigid the family system hierarchies arc. the more serious may violent expressions within the family be: (3) the more rigid the family interactions are. the more serious may violent expressions within the family be: (4) family members’ autonomous life is inversely related to the intensity of violence; to (5) the greater family members’ adhesion cultural stereotypes about the family and to gender stereotypes, the more serious may violent expressions within the family be; (6) the purpose of the weaker family members of ‘running away’ from stereotypes about family relationships and from gender stereotypes may trigger off violence within the family; (7) a greater interaction with the outside world promotes a ‘denaturalization’ of violent behaviours within the family; (8) a greater interaction with the outside world promotes the denouncement of violent behaviours within the family. EXPLANATORY
MODELS ABOUT FAMILY VIOLENCE
At the beginning explanatory models intrapersonal models
of research on this subject, about family violence were focused on medical variables.
Gradually, these models were replaced by broader points of view focused on sociopsychological variables. We will summarize some of the models proposed to explain family violence: (I) Intrapersonal models underline that violence is originated on the subject’s psychological abnormalities. Thus, profiles of the ‘batterer husband’ or of parents responsible for children abuse were outlined [6]. For instance, Wetzel and Ross [7] proposed a profile of men who batter that included the following features: partner’s jealousy; partner’s control and isolation; Jekill and Hyde personality; explosive temper; legal problems; projection; verbal as well as physical abuse; history of family violence; more violent when partner is pregnant or soon after she gives birth; denial and cycle of violence and contrition. The same authors characterized battered women as follows: she accepts traditional sex roles; she accepts malt dominance and the myth of male superiority; she equates dominance with masculinity; she accepts ‘partner’s reality’; the feelings about her own worth arc based on her ability to ‘catch’ and hold a man; she suffers from a low self-esteem. (2) In world literature the sociostructural model is the most widely applied one. This approach emphasizes social structures, norms and values as causal variables in the process of family violence. In many of these studies, maltreatment is seen as arising from changes in traditional ways of life. Researchers who use this model have focused on the changing demands placed on the family by society, creating unreasonable demands on it [8]. (3) The social learning approach emphasizes the influence of variables such as occupational status and parental modelling on the onset of violence. A study by Howell and Pugliesi [9] particularly states that an unsatisfactory employment status strongly increased the likelihood of violence in younger subjects (aged ~40 years). Older subjects (aged ~40 years) could endure several strains simultaneously. Barling and Rosenbaum [IO] also found that, in general terms, stressing work experiences were significantly associated with wife abuse. (4) Sex role socialization has been strongly associated with family violence, through stereotypes of both genders, devaluation for women’s work inside and outside the home and socially condoned family violence. Findings stress the importance of analysis of the family as a locus of struggle, pointing to gender and age structuring as a source of power differences. Within this model, the domination-submission relationship is at the ground level of violence, and the perpetuation of family violence is showing that the hierarchical model is still at the basis of social functioning.
Domestic violence-an Carroll [ 1 I] found that the transmission of violence was more likely to occur within same sex-linkages. Women’s work and independence seem to be the structured conditions for change of the couple’s relationship, but transition towards more egalitarian forms of relationship may generate tensions that result in greater possibilities of violent events within the family. As Bremes and Gordon [I21 assert from this point of view, violence is not random and haphazard. A gender and generational understanding of family violence requires that the analyses focus on who is violent to whom, how violence is expressed, and what its effects are. In this way, patterns will emerge more clearly than visualized at this moment. (5) The frustration-aggression hypothesis has been also widely applied to family violence, based on the idea that, in this realm, it appears as a deviation from the public world to the private one, rendered possible by the standing of its tolerance within the latter. Berkowitz’s [ 131 review reformulates Dollard’s [ 141 hypothesis of frustration-aggression. taking into account that a frustration capable of evoking aggression must involve the non-attainment of an expected reward. rather than a mere deprivation. In this sense. the implied frustration could be that the subject is unable to reach his expectations about family members. (6) During the last few years, attention has been set on the importance of causal attributions in the couples’ dysfunctional relationships [ 151. A large proportion of couples attribute their negative behaviours to internal causes, thus underlying the negative impact of these behaviours. The results of researchers carried out along this line point out that couples with problems assign causal and responsibility attributions that minimize the impact of their mate’s positive behaviour and maximize the negative one. Self-blame described about battered women is an example of these attributional patterns that seem to be distinctive in violent relationships. Research on the attributions made by victims of crimes suggest that they tend to blame themselves for their victimization [ 161. Theories of self-blame developed from victims of assault and robbery have been applied to studies of battered women, to better understand their perception of the causes of their victimization. It is said that self-blame restores the victims’ control over the environment, so that a positive adjustment in those circumstances may be possible. However, self-blame may not be a functional coping mechanism to avoid future abuse. On the other hand, the study of attributions made on close relationships can influence clinic work, since therapy may contribute to the couple making milder attributions both towards themselves and towards their mates. (7) Another explanatory model is the one proposed
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emerging health issue
by social constructivism [17], for which it is impossible to differentiate between facts and values in social life. Attitudes, expectations, sanctions and demands from the social context over the family have a great importance in violent behaviours. This model points out that couple violence is not only the result of a transaction between a man and a woman, but that it emerges from past, present and future interactions of individuals related to the social context. (8) On the other hand, the systems theory points out that the victim-victimizer scheme, as a description of family violence, escapes from family consideration as a system in which interactions take place as a consequence of each other, in positive or negative feedback flows. Researchers who work with this model take into account the couple system, the nuclear family system, the extensive family system, as well as the therapist-family system, when there is therapeutical intervention.
DESCRIPTION
OF CLASSICAL
FAMILY
VIOLENCE
SYNDROMES
The impact of violence in the family goes well beyond its immediate effects on victims and assaulters. It creates irreparable damages to the entire family. Nevertheless, it is possible to describe the following distinctive syndromes: I Battcwd
women
The characteristic is the husband’s repeated physical aggression to his wife. It is interesting to notice that the expression ‘battered man’ does not appear in literature, the cases of violence experienced by men from women being reduced to isolated behaviours, not to reiterative ones. The fact that attacks are repeated and that blows are multiple constitute the battering. Regarding the dynamics of violence in marriage, it has been said that the problem of violence begins when a man with low frustration tolerance is paired with a highly provocative woman [18]. Besides, many women report the feeling of tension before violence, but they don’t know how to stop it. The syndrome has been assimilated to posttraumatic stress. Its main features appear to be anxiety-related symptoms in response to stressors, evidenced as physical or psychological problems. Since it is known that trauma produces stress related symptoms, it is likely that battered women will evidence physical or psychological problems along time. They also reported a significantly higher level of somatic complaints [19]. Follinstad et al. [20] think that the inability to predict the moment when abuse will take place results in more anxiety symptoms for these women. Women with very severe symptoms also have little
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ASA LIA KORNBLIT
social support. Consequently, they are not protected by the stress buffer function. Lowered self-esteem and more severe depressive symptoms were found in women with minimal personal resources, lack of institutional and informal social support and greater avoidant coping styles [2]. Therefore, stress and personal resources have indirect effects on functioning, through their impact on coping responses and the non availability of social support [22]. Results from regression analysis indicate that selfesteem contribute as a more unique variance to physical aggression than depressive symptomatology. Continued and repeated physical abuse seems to have a more lasting and dramatic effect on the self-esteem of these women than on their depressive symptomatology [23]. Women who experienced more types of emotional abuse showed more physical and psychological symptoms. Thus, as Follinstad et al. [20] express, the experience of emotional abuse is a possible reason for an early deterioration of health. The effects of a decline in physical health persist to some extent even when abuse ceases. Seligman’s [24] concept of ‘Icarned helplessness’ as a state characterized by a sense of the impossibility of reaching goals from ones’ own behaviour is consistent with the description of the battered woman’s syndrome. Although marital rape is not necessarily an aspect of all battering relationships. violent sex separated from other forms of violence is rare. There are few studies on this subject. Particular emphasis has been put on the reasons that keep battered woman captive [7]: financial dependence, fear and family and religious values were mentioned as the main features. Other features recognized were: lack of admission of marriage failure, self-blame and marriage worth above everything. Understanding the decision to leave an abusive relationship is central for theoretical and practical purposes. It has been said [25] that the decision to leave or remain in an abusive relationship is a ‘rational’ decision, though the outcome may be considered abnormal by normative standards. The process has been studied from the point of view of four theoretical models: (I) Psyhologicul entrapment, which is described as “a decision process whereby individuals escalate their commitment to a previously chosen though failing course of action in order to justify prior investments” [26. p. 51. In other words. entrapped individuals think they have “too much invested to quit” [22]. The more time and effort the woman invests, the harder it becomes to give out without success and the less likely that a battered woman will leave the relationship [29]. (2) Learned helplessness. Walker [4] suggested that battered women can be characterized as exhibiting
learned helplessness, a syndrome coined by Seligman [24] to describe a perceived non-contingency between responses and outcomes, that gives rise to the expectation that future responses and outcomes will also be independent. On a descriptive level, the learned helplessness model provides a compelling account of the battered woman syndrome: the continued abuse despite efforts to make the relationship function communicates a lack of contingency between responses and outcomes. (3) Relative costs and bemfits. A third model that can be used to examine decisions to leave abusive relationships derives from the exchange theory, which is based on the premise that such a decision follows from a cost and benefit analysis of current relationships, compared to alternative ones. This cost-benefit analysis [29] is useful in identifying multiple responses to abusive relationships. . (4) The theory qf reasoned action. Proposed by Fishbein and Ajzen [30], it holds that thoughtful actions and decisions are directly related to behavioral intentions. These are in turn determined by: (a) the attitude toward that behaviour; and (b) the subjective norm. According to this model, a woman may not intend to leave an abusive relationship because her beliefs about the consequences of that action underestimate or overestimate the real probabilities. For example, women may doubt that abuse will really end if they leave, or they may think it unlikely that they can gain financial independence. Or they may not dare to leave because they think their social network will not approve their behaviour. A second problem could be a high motivation to comply with those who believe they should stay. This model provides a potentially invaluable aid for intervention. Altering unrealistic evaluations calls for interventions that educate and inform to change the perceived desirability of the consequences of Icaving. As Strube [25] says, although a fair amount of knowledge has been accumulated regarding relationship decisions, our understanding of the dynamics of this decision process is still weak. Each one of the described models provides a perspective for viewing relationship decision, but future research should examine the ways in which they can be integrated to improve their predictive power, so as to “spare many women needless and senseless suffering” (p. 248), -3. Courtship uiolence One of the aspects that has been studied about family violence repetition is the violence exerted during courtship. A study developed by Smith and Williams [31] showed that students who had been abused by their parents accepted anger as a ‘natural’ feature of human relationships and abused their dates, using I I out of 13 types of violence presented by the researchers.
Domestic violence-an Several forms of violence shown by the results of the study were painful and sophisticated, indicating that they were part of a repertoire of action as well as premeditated. It is assumed that most of these forms of violent dating were learned within an abusive household. But we still need a research that will explain why so many youngsters who are involved in violence when dating come from households where there is no violence. At the same time, a significant number of surveyed youngsters who had been abused by their parents ended a dating relationship because of a display of violence. But also, a more significant number of abused respondents indicated that they continued to date a person who acted violently towards them. These findings question why, under certain circumstances, the violent model learnt by the subject from his/her own family can work as a stimulus to search for other types of bonding, withdrawing from repetition, and why, under other circumstances, it works as a model that the subject repeats with his/her own couple and family. New researchers on this subject could explain some important questions about the onset of family violence. 3. Child abuse In 1962 Henry Kempe published an article [32] in which they described the “battered-child syndrome”, resulting from harmful actions by parents or foster parents. Lately, in 1970, David Gil [33] proposed a broader definition of child abuse which included neglect. The concept comprises, according to Gulotta [32]: (a) (b) (c) (d) (e)
physical aggression; sexual disturbance and violence; neglect related to health and protection; physical forlornness; emotional forlornness.
The diversity of child maltreatment suggests some cultural factors and values associated with child abuse [38]. As described in the medical literature, the clinical signs of the battered child syndrome include bruises, welts, lacerations, abdominal injuries, ocular damage, burns and bone fractures. The syndrome called ‘failure to thrive’ has been associated with the neglect of children. Here, children fall below the third percentile for weight and height, with slowed neurological and psychological growth, and with no signs of organic illness to account for the deficiencies. The syndrome has been described in families in which mothers cannot fulfil their children’s emotional and nutritional needs.
emerging health issue
1185
Physical abuse is most often associated with oppositional child behaviours, whereas neglect is characterized by adult failure to assume basic responsibilities on behalf of the child. Therefore, the neglecting parent may show a more chronic pattern of interpersonal conflict and apathy than the abusive parent [36]. One of the effects of child abuse is the impairment of socioemotional and cognitive development [37]. On the cognitive developmental level, the abused child is frequently placed below half of his intellectual and linguistic competence. On the socioemotional developmental level, a pattern of avoidance, withdrawal or coolness, as a sequel of either physical or psychical maltreatment has been described for the abused child. The child abuse sociocognitive profile includes little confidence on his/her powers to influence on events or their modification, and the attribution of their control to external factors. It has been also said that there is a relationship between the lack of inner control perception and a low self-esteem, with difficulties to prevent events and over watchfulness. In terms of Piaget’s [38] model, we can find an extended pre-operational stage in cognitive development in these children, along with cognitive egocentrism and with difficulties in recognizing the others’ perspective. This last point is considered as a preceding element of empathy, and its weakness can also explain the over watchfulness and distrust showed by abused children, since it hinders the evaluation of the feelings and behaviour goals of the others [37]. However, other research results [39], suggest that the deficits in cognitive functioning apparent in abused children are no more pervasive than those found in children from low socioeconomic backgrounds. Thus, it may be that depressed family circumstances common in violent families, and not maltreatment per se, are responsible for the cognitive deficits often noted in abused children. Stressful events than can not be controlled, present in those environments, deny children the sense of mastery that might encourage learning. Moreover, as Herrenkohl [40] conclude, the parents’ deficient coping skills are transmitted to the child via: (a) modelling of inadequate coping strategies; (b) inadequate provision of an encouraging and supportive environment; (c) a locking of parent and child into a vicious circle of negative reinforcement. Weissman-Wind and Silver [41] explore whether child abuse constitutes a generic risk to survivors’ adult adjustment, or whether, instead, physical, sexual or combined abuse has specific, differential adult correlates.
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ANA LIA KORFCBLIT
The findings suggest a highly generalized response to abuse, regardless of its specific sexual or physical nature. These results fortify the trauma model hypothesis, taking into account that the combination of sexual abuse and physical maltreatment appears to be as detrimental as the severest forms of sexual or physical abuse. The major debate with respect to child abuse relates to whether or not it represents a phenomenon distinct from general maltreatment of children, and whether special programmes are needed to face it. It seems that there arc variations within a continuum of severity of maltreatment. In developed countries the movement seems to be one of improving care for all children, rather than developing specialized programmes. However. in Third World countries. children at risk may be the target for particular programmes, as basic needs arc not fulfilled for large groups. As Gellcs and Cornell [8] stated. a major concern in a Third World definition of abuse is the impaired development of children or even death resulting from adverse environmental conditions that could be prevented by way of adequate health scrviccs. ‘Nutritionally battered child’ is a term coined to include prolonged protein malnutrition which includes pre-kwashiorkor and recurrent kwashiorkormarasmus syndromes.
EXPLANATORY
MODELS ABOCIT CHILD-ABLSE
The initial conceptualization of abusive parents assigned primacy to cognitive, affective and motivational factors in the adult and a lesser importance to contemporaneous variables. Case studies have addressed hypothesis rclatcd to early childhood experiences and personality profiles of abusive parents to support the idea that parental psychopathology is responsible for child abuse. In general terms. the studies that use measures of underlying personality attributes or traits have been unable to detect any patterns associated with child abuse. beyond general descriptions of displeasure in the parenting role.
Bowlby’s [42] model about the importance of the relationship with the bonding figure and the predictive capacity of the quality of this first regarding later maltreatment has relationship constituted the framework for many studies on child abuse. However, the concept of bonding may be culturally tinged and it may be of limited usefulness in a cross-cultural comparison. For instance, there is apparently no child abuse in cultures where separation of mother and child takes place during an early phase.
This model relates child abuse with situational events which exert an influence on parental competencc. These studies analyse psychological processes such as cognitive skills. family roles. expectations and child related experiences. all of which could lead to defined competence differences in situationally among parents [43]. These findings guide prevention efforts at reducing situational demands and at developing learned experiences for abusive parents, rather than sending them to a psychiatric unit.
This model represents a contrasting viewpoint of child abuse that puts emphasis on antecedent events that may prccipitatc and maintain child abuse, as well as on interactional patterns within the family [44]. Within this context. the target child is viewed as an active participant in an escalating cycle of coercion [451. It is considcrcd that child aversive behaviour and ;I stressed environment precipitate conditions that interact with parental competence. In this connection, child abuse is considered as an attempt made by the parents to gain control over multiple environmental avcrsivc cvcnts. Socictics where physical punishment techniques are infrequent arc societies with extended family houscholds who are alternative caretakers in the household and share child rearing responsibilities. This fact would support the hypothesis about the origin ol tension on the parents -offspring relationship. based on demands which parents are not capable of answcring.
CHII.1) SEXUAL
ABUSE
According to Browne and Finkelhor [46] child sexual abuse consists of two overlapping but distinguishablc types of interaction: (a) Forced or coerced sexual behaviour imposed on a child; and (b) sexual activity between a child and a much older person, whether or not coercion is involved. There is a lack of evidence for common symptoms in children who have been sexually abused; on the these children manifest a variety of contrary. symptoms [47]. Nevertheless. Corwin [48], Wolfe et ul. [49] and other authors mention that sexualized behaviour and post-traumatic stress disorders frequently occurred in these cases. The post-traumatic stress disprder results from experiences that arc overwhelming. sudden and dangerous [50]. Finkelhor and Rosenbaum [51] suggest that sexual
Domestic violence-an abuse traumatize children types of mechanisms: (1) (2) (3) (4)
through
four distinctive
traumatic sexualization; betrayal; stigmatization; powerlessness.
In spite of this, there are few theoretical advances about what causes the children to be symptomatic. Two types of effects of sexual abuse can be distinguishable: (a) Short term Qkts, which are early reactions produced within two years of the termination of abuse, and include reactions of fear, anxiety, depression, anger and hostility, as well as inappropriate sexual behaviour. (b) Long term efects, with depression as the symptom most commonly reported among adults who suffered sexual abuse as children. Self-destructive behaviour, anxiety, feelings of isolation, poor self-esteem, a tendency toward revictimization, difficulty in trusting others and sexual maladjustment have also been recorded by other researchers. In general terms, there is no factor on which all studies agree as being associated with a worse prognosis, though the victim’s non-supporting families could contribute to a worse evolution.
VIOLENCE
WITNESSING
CHILDREN
Both marital violence and non violent marital discord were found to be related to behavioural and emotional problems in witnessing children [52]. The research carried out by these authors showed that exposure to marital discord or marital violence had a greater generalized effect on children’s emotional health than a punitive parenting style, which was related more specifically to behavioral disorders. This research refutes the behaviour modelling character of family violence experiences lived passively,
though
its lasting
effects
on
personality
are
shown. Hinchey and Gavehck [53] found that the early and pervasive influence that marital discord may have on young children is expressed by an impairment of their empathic abilities, measured through four scales: role enactment. social inference, role taking and social behaviour.
SIBLING
VIOLENCE
The effect of violent experiences with siblings should be given a greater consideration than it has been given in literature. A study developed by Gully [54] showed that this type of family violence was a significant predictor of self-reported violence and of self-predicted violence in hypothetical situations.
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emerging health issue ELDERLY
ABUSE
Elderly victims of abuse are not visualized as clearly as other members of the family. For instance, community resources for both the elderly abused and their abusers are lacking [55]. Both sibling violence and elderly abuse should be studied more deeply and should be the object of research and of community programmes focused on these subjects. EPILOGUE
Resort to violence in family relationships implies a failure of language as an instrument of human understanding. Consequently, family violence implies the existence among the members of the group of weak communication skills, which are summed up to an equilibrium breakdown when one of them attempts a ‘running away’ from family cultural stereotypes and/or from gender stereotypes. Since it is supposed that this ‘running’ will be reached through a long process towards more egalitarian relationships-that have only began in some places-, it is possible that prevention should centre on the improvement of communication skills within the family, as a way of endowing people who suffer strong pressures originated in individual, social and cultural tensions, with better resources to cope with them. School should not be away from this purpose. REFERENCES
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