A funny thing happened to me on the way back from the New Hampshire Governor’s Statewide Conference on Domestic & Sexual Violence. I don’t mean funny in a comedic sense, but rather in an unexpected, shocking sense. During that conference and in its aftermath, I learned first-hand very important lessons about domestic violence (DV). At the time, I was a member of the NH Governor’s Commission on Domestic & Sexual Violence (Substance Abuse & Mental Health Committee). I was invited to lecture at the annual meeting, which was held at the famous and truly spectacular Mount Washington Hotel. The views from the hotel’s wraparound deck are breathtaking. The restored interior is an exemplar of historic grandeur. I always looked forward to the conference, not only because it was well done, but because of the chance to get away to beautiful Mount Washington ambiance.
Yet in 2004, the DV conferences at the Mount Washington came to an abrupt end. They were subsequently hosted in another hotel. The reason? “The Cave.” Underneath the famous hotel, there remained an authentic, secret “speak easy” from the days of prohibition. The Cave had been refurbished into a novel, impressive bar with a rather curious ambiance. (One might be inclined to call it risqué after a certain hour in the evening, and with a certain clientele.) During that last meeting, a prominent district attorney and a respected judge were accused of sexually inappropriate behavior in The Cave. This at a function to promote awareness and prevention of domestic and sexual violence!
I didn’t learn about this accusation until after the conference. I had been asked to lecture on DV risk assessment early the next morning, and had elected to turn in early after getting my lecture materials in order. I had prepared my lecture carefully, and even had a video vignette in which I interviewed an individual with a long history of committing DV. After discussing risk factors in my lecture, I would then show the video and invite the audience to pick out as many risk factors as they could for discussion.
At the beginning of my lecture, I stated clearly that my talk would be restricted to the subject of male-perpetrated DV. Most of my experience in the field came from my work in corrections and consulting with stalking victims. Thus, I could really only claim expertise on DV perpetrated by men. I stated that I was fully aware that females can commit DV. But I was there to speak about what I knew best.
I could sense “him”—a learned colleague—in the audience long before he ever asked his questions. He was sitting in the front row taking notes furiously, and paying far more attention than medical students do when I lecture. When it came time for audience questions, he pounced. “Are you aware of the work of Dr Fiebert, which shows the substantial role that women have in perpetrating domestic violence?” he asked. “Well . . . yes,” I replied, maintaining a friendly and measured tone. “I have some knowledge of it, but as I mentioned, my area of expertise comes from corrections, where the vast majority of inmates are men.” My colleague retorted, “I just think it is important that people are aware of his findings, and the evils of female-perpetrated DV.” At that point in my career, I had not yet learned how to deal with such a situation. So I responded, as I had been taught by a mentor: “Alright. I see your point. Next question?” (For the proper effect, the word “alright” must be pronounced clearly, drawn out, and with an air of significant authority.)
Several months after my presentation, I was alerted to the fact that my lecture had been cited on a Web site that proclaimed strong father’s rights interests. The citation was not flattering. The “review” of my lecture proclaimed that I had said things I had never uttered, and went on to describe my efforts as “questionable scholarship.” I was not used to anyone, other than an opposing attorney, proclaim that I had said something I was certain I had not said. I opted to simply let it go and to move on to the “next question.”
From these events, I learned 3 important truths about DV:
• DV is not confined to any one sex, socioeconomic strata, or race.
• DV is very often associated with substance misuse.
• The field of DV can sometimes be fraught with controversy—particularly around issues of gender.
Victims of DV suffer mentally and physically—regardless of who perpetrates the abuse. And sadly, DV often involves children who either witness or experience the violence. DV has devastating effects on children, which may even begin in utero. The adverse psychological effects have been observed to endure even after measures have been taken to secure children’s safety, and at least 1 study showed that among victims of DV, suicidal ideas persist into young adulthood.
Who perpetrates “the most” DV—men or women? We aren’t likely to have the “definitive” answer any time soon. But I wonder if it really matters. Both historical and present-day research clearly document how women have been victims of violent control by men. Newer data suggest that women may also commit DV. And there is a developing body of research on DV between same-sex couples that is quite alarming. For psychiatrists, the overarching goal must be an awareness of the associated signs and symptoms of DV, and being willing to question clients about it in a sensitive and professional manner.
Incidentally, anyone left wondering about the gender of the judge and DA? Does it matter? Both lost their jobs—and the rest of us lost the opportunity to enjoy the annual conference at Mount Washington Hotel.
Note: Dr Knoll has compiled a summary of domestic violence–related literature. A PDF of that summary can be found on www.psychiatrictimes.com.
Dr Knoll is associate professor of psychiatry at the SUNY Upstate Medical Center in Syracuse, NY, where he is director of forensic psychiatry, and director of the forensic psychiatry fellowship at Central New York Psychiatric Center. He is also the editor-in-chief of Psychiatric Times.