Strengthening Health System Responses to Gender-based Violence in Eastern Europe and Central Asia

A resource package

1.4. Understanding the dynamics of violence in intimate partner relationships

Women survivors of violence presenting in a health care setting often to not disclose their experiences. Even in case a patient discloses that she has experienced violence from an intimate partner, health professionals might find out that she is seeking medical help but not willing to leave the abusive relationship.

Many health professionals share the norms, beliefs and attitudes of the broader society in which they live. Negative attitudes towards women in general and towards survivors of violence in particular can inflict additional harm upon women who experienced violence and may prevent health professionals from providing adequate medical care. Not understanding the dynamics of violence may leave well-meaning health professionals frustrated and lead them to think that this woman does not need or even deserve help, wondering “why doesn’t she accept help and leave the abusive relationship?” The survivor might even be blamed for her situation. Understanding the dynamics of violent intimate relationships can help health professionals to maintain a supportive, non-judgemental and validating attitude vis-à-vis survivors of violence, which is an important prerequisite of an effective health system response to GBV. For further information refer to section 2.3 on the role of health professionals and to section 3.1.4 on communication with survivors.

Improving provider attitudes and beliefs about GBV should therefore be considered a central responsibility of every health facility; however, this is a challenging task that requires a long-term approach.

This sub-chapter provides a selection of models and theories commonly used to illustrate the dynamics of violent intimate relationships. These models show how power and control are used to maintain women in a position of subordination and control that in turn perpetuates the violence. The section 1.4.1 explain the power and control wheel, the 1.4.2 the cycle of violence, the 1.4.3 the Stockholm syndrome and finaly the 1.4.4 the concept of normalization of the violence.

1.4.1 The Power and Control Wheel

ThePower and Control Wheeloffers a framework for understanding the manifestations andmechanisms of power and control in an intimate relationship (WHO 2005). This model was developed by the Domestic Abuse Intervention Programs in Minnesota, US, weaving in the experiences of women survivors of intimate partner violence who had participated in focus groups. The wheel consists of eight spokes that summarize the patterns of behaviours used by an individual to intentionally control or dominate his intimate partner: using intimidation; using emotional abuse; using isolation; minimizing, denying and blaming; using children; using male privilege; using economic abuse; and using coercion and threats. These actions serve to exercise “power and control” – these words are in the centre of the wheel. The rim of the wheel is made of physical and sexual violence – this violence holds it all together (see figure 2; Domestic Abuse Intervention Programs undated).

Figure 2: The Power and Control Wheel

1.4.2 The Cycle of Violence

The model of the “cycle of violence”wasdeveloped by the American psychologist Lenore E. Walker in 1979. It describes the course of a violent relationship in three phases or cycles:

  1. In the first phase, tensions gradually build up. The woman tries to appease her partner, generating a false sense of being able to control his aggression and prevent violence.
  2. This is followed by the second phase, an episode of physical, sexual and psychological violence which ends when the perpetrator stops the abuse temporarily.
  3. In the third phase (“honeymoon” phase), the perpetrator apologizes and promises to change his violent behaviour. He may show especially loving and gentle behaviour; this makes the woman believe that there is a “good” side to her violent partner, which she can retain through adjusting to his behaviour by modifying her own (Walker 1979, cited in Stark 2000, WHO 2005).

The cycle of violence is being repeated; over time, the phases of aggression increase in regard to both, severity and duration, while the “honeymoon” phases become shorter (BMWFJ 2010). In this situation, women develop a strategy for survival that may include extreme passivity- denying the abuse, refusing help offered and even defending the aggressor (Walker 1979, cited in Stark 2000).

1.4.3 The Stockholm syndrome

The so-called Stockholm syndromeis used to explain why women remain in violent relationships. It was first observed in 1973, when bank robbers in Stockholm took four people hostage and held them for six days. During this period, the captives developed a close relationship with the robbers and regarded the police as enemies. In a survey of over 400 women survivors of intimate partner violence, Graham and Rawlings identified a similar response pattern among women who experienced violence by an intimate partner. These women tend to develop close bonds and even identify with the perpetrator as a coping strategy in order to survive. If the violent partner is willing to make even small concessions or shows some degree of friendliness, the woman has new hopes and is ready to give the abuser another chance. The Stockholm syndrome may develop under four conditions:

  1.  The life of the survivor is threatened.
  2.  The survivor cannot escape or thinks that escape is impossible.
  3.  The survivor is isolated from persons outside.
  4. The captor(s) show(s) some degree of kindness to the survivor(s).

Graham and Rawlings discovered the Stockholm syndrome is a common experience of persons who experienced severe trauma and violence and do not see a way out of their situation, such as abused children, sect members or prisoners of war. After a certain time, they begin to identify with the aggressors – in order to survive. Thus, women survivors of violence do not develop specific psychological coping patterns; rather, they react like other people in a similar situation (Graham et al 1988, cited in WAVE 2006).

1.4.4 The concept of normalization of violence

The concept of normalization of violence developed bythe Swedish sociologist Eva Lundgren explains why women living with a violent intimate partner find it difficult to name and define their own experiences as violence because living in a violent relationship changes their interpretation and understanding of the violence experienced; they adopt the violent partner’s understanding of violence. As a consequence, women might perceive an attack which an outsider would regard as violence as manifestation of their own failure. Furthermore, women survivors are reluctant to identify themselves as “battered women” and their partners as “abusers,” as this would imply acknowledging that they and their partners are deviants from the norm of an equal relationship. It is also important to understand that defining the violence as something else than violence or playing it down can be a coping strategy while living in a violent relationship. Research has shown that only after the woman has left the violent relationship, when she no longer faces isolation, control and risk of further violencefrom her former partner, the process of “denormalization” of violence begins, which enables her to name her experiences as violent (Lundgren 1993, cited in Lundgren et al 2001).