Can Understanding Neurobiology Provide a Better Approach to Working With Abuse Survivors?

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Analysis Violence

Can Understanding Neurobiology Provide a Better Approach to Working With Abuse Survivors?

Victoria Law

"It doesn't take much digging to see what's there is trauma, layers and layers of trauma," said Dr. Elizabeth Fitelson during the morning panel of Arresting Survival, a recent New York City conference focusing on domestic violence survivors.

According to the National Coalition Against Domestic Violence, in the United States alone, nearly 20 people per minute are physically abused by their partner. This comes out to more than ten million people each year. One in three women and one in four men have been victims of physical abuse by an intimate partner at some point in their lives.

Given the frequency of incidents, then, how can health-care professionals, advocates, and attorneys best work with domestic violence survivors? Some professors say that understanding neurobiology—how the nervous system processes and mediates behavior—can help them do so by connecting the dots between trauma, mental health, and domestic violence.

“It doesn’t take much digging to see what’s there is trauma, layers and layers of trauma,” said Dr. Elizabeth Fitelson during the morning panel of Arresting Survival, a recent New York City conference focusing on domestic violence survivors whose abuse led to their own arrest, prosecution, and punishment. “This is something that anyone working in the field of mental health should be aware of.”

Trauma is exposure to a distressing event, such as death or threatened death, actual or threatened injury, or actual or threatened sexual violence—all of which can be part and parcel of domestic abuse. According to the American Psychiatric Association, the exposure need not be experienced firsthand; trauma can also occur when a person witnesses a traumatic event, or learns that a traumatic event happened to a loved one or close friend.

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And, as Fitelson noted at the conference, it can have lasting neurobiological consequences. “A 6-year-old exposed to trauma has a brain that looks different than [that of] a 6-year-old not exposed to trauma,” explained Fitelson, who is the co-founder and director of the Women’s Program at Columbia University Medical Center’s Department of Psychiatry and the co-director of the Columbia Psychiatry Domestic Violence Initiative, which provides psychiatric care to domestic violence survivors at the Bronx Family Justice Center. But, she hastened to add that scientists are still examining the significance of that differing brain: “We don’t exactly know what that means.”

She also cautioned against the common misconception that biology is hard-wired and irreversible. “This is not the case,” she noted. “The true story of trauma is resiliency.”

Even so, trauma can have lasting consequences. For example, the Adverse Childhood Experiences (ACE) Study, which remains the largest study of short- and long-term effects of childhood trauma, found that those early experiences are powerful determinants of who a person becomes as an adult. From 1995 to 1997, researchers interviewed more than 17,000 people about their childhood experiences to examine the health and social effects of adverse childhood experiences over the span of a lifetime.

The study found that children whose trauma had never been addressed are much more vulnerable to being revictimized by rape or domestic violence. According to the ACE study, women who had four or more adverse childhood experiences are 500 percent more likely to become victims of domestic violence and almost 900 percent more likely to become victims of rape.

In addition, the risk of perpetrating domestic violence increases for both women and men who have experienced five or more adverse childhood experiences. In other words, the study confirms the adage, “Hurt people hurt people.”

Trauma, including that stemming from abuse and domestic violence, can also lead to post-traumatic stress disorder (PTSD), in which survivors re-experience trauma through flashbacks or recurring dreams. Those with PTSD experience a range of negative emotions, ranging from a persistent and distorted sense of self-blame, estrangement from others, or a significantly diminished interest in activities and an inability to remember important aspects of the traumatic event. Those who experience long-term trauma, such as people who are abused as children and later as adults, or people who experience sustained abuse and powerlessness, are at risk of developing complex PTSD. People with complex PTSD often experience difficulty managing their emotions—including anger—and may experience severe depression, suicidal thoughts, and a sense of hopelessness about the future.

Studies suggest that unresolved trauma can, in addition, trigger alcohol and drug use; involvement in violent activity; or other behaviors that may lead to arrest. A 2001 study by the U.S. Department of Justice found that experiencing childhood trauma increases the likelihood of being arrested as a juvenile by 59 percent, as an adult by 28 percent, and for a violent crime by 30 percent.

Without more data, however, more explicit links between the specific trauma of domestic violence and criminal justice involvement are unknown. As reported earlier in Rewire, no one seems to know how many domestic violence survivors are arrested and prosecuted for acts stemming from their abuse—only that, among women in prison, there is considerable overlap between domestic violence and incarceration. The most recent national data available remains a 1999 U.S. Department of Justice report stating that nearly half of women in local jails and state prisons had been abused prior to their arrest. In New York state, prison officials found in 2005 that 67 percent of women sent to prison for killing someone close to them had been abused by that person. Neither set of statistics include trans women being held in men’s jails or prisons. They also do not document or include survivors who have been coerced into other crimes, such as robbery, by abusive partners.

Furthermore, criminal justice systems themselves—as well as the courts, foster care, schools, law enforcement and health care—can become additional sources of violence for survivors. “We have a societal reaction of using law enforcement as a response to trauma rather than understanding incarceration as a form of trauma,” said Andrea Bible, an attorney at the Legal Aid Society, at the conference. In other words, she cautions that automatically calling the police when domestic violence occurs may lead not to safety, but to additional violence. Bible should know, having spent more than 14 years working with domestic violence survivors charged with or convicted of crimes stemming from their abuse. At the conference, she noted that every survivor she’s spoken with over the years has told her that violence and trauma is built into the jail itself.

“Think about what strip searches mean,” she said. “It’s a violation that people experience daily.” Upon release, survivors are not necessarily any safer from abusive ex-partners. She recounted working with one domestic violence survivor who was released from prison and into a program. Her ex found and assaulted her, threatening to burn the program down. Rather than working with her to safely transition to another program, the program expelled her as a potential risk. Bible was eventually able to get the woman into transitional housing affiliated with a domestic violence shelter, but until then, the survivor was on her own.

In general, understanding this landscape of trauma can improve approaches to working with survivors. Trauma-informed principles include acknowledgment, safety, trust, choice and control, compassion, collaboration, and a strengths-based focus. This means, experts say, approaching survivors in ways that take time and require empathy:

  • Ensure the survivor’s privacy. In other words, don’t expect to have the conversation in a room where people are coming and going.
  • Ask the person their name in a conversational manner and give them yours.
  • Don’t tell the person to “calm down” or “relax.”  Instead, frame questions and statements with empathy.
  • Be sure to engage in active listening—keep your attention on them and maintain eye contact.
  • Rather than crossing your arms or putting your hands on your waist, keep your body language open, calm and relaxed. This can include smiling (when appropriate), expressing concern, and mirroring their body language.
  • Don’t tell them that they should feel a certain way. Instead, confirm and normalize the person’s feelings. So if a person recounts feeling confused after being assaulted by a loved one, say “Anyone would feel confused after being hit,” rather than “Why didn’t you leave after he hit you?”
  • Don’t be surprised if the explanation, or the order of events, changes. It is common for survivors of trauma to describe parts of their experience differently from one telling to the next, to talk about the sequence of events in random order rather than chronologically, to go off on tangents, or to have what’s known as a “flat affect” (speaking in a monotone and appearing to have little emotion). That’s because when the brain senses a threat, it releases hormones that cause the body to shut down in certain ways; this shutting down affects how and where memories of these events, as well as the person’s emotional responses, are stored. Later, these memories—as well as the survivor’s retelling—are more likely to be disjointed and out of sequence.
  • Provide the survivor with as much control as possible. Abuse leaves a person feeling powerless and out of control. If the person seems hesitant, ask questions and give them the time and space to answer. Understand that the person may need time to decide how they feel.
  • Focus on the person’s support system: Ask about family or friends, and help them decrease their sense of isolation.
  • Offer support regardless of the survivor’s decision. If the survivor chooses not to call the police or to stay in the relationship, don’t withdraw support or pressure them into a different decision. Instead, offer support to help them do so safely.

At the conference, Afua Addo, the women’s services coordinator at the Center for Court Innovation, said the effects of trauma may look different than what service providers may imagine. “Imagine a bear comes onto the stage,” she challenged the audience. Reactions would vary—many people would, hopefully, leap out of their chairs and run out of the auditorium. But some might freeze in place.

“If you freeze when encountering a bear, you’re perceived as having something wrong with you,” she noted. Similarly, attitudes toward domestic violence often follow the same line of blaming the victim for reacting to violence in certain ways—an approach that needs to change.

For safety and healing, Bible said, we should invest in community resources, rather than relying on law enforcement and a criminal justice system that may misinterpret or even worsen the consequences of abuse.  “We need to reorient society towards preventing and healing from trauma,” she said.