ASSAY: A JOURNAL OF NONFICTION STUDIES
While running an advocates program at a small liberal arts college in upstate New York, I often find it useful to distribute creative nonfiction to advocates-in-training. Our advocates function as first responders to incidents of sexual assault, stalking, and intimate partner violence (IPV). They run a 24-hour hotline/chatline, and help survivors navigate the legal, medical, and educational bureaucracies in the wake of a trauma. Frequently, crisis advocates must be able to explain traumatic conditions to people (doctors, lawyers, and university administrators) unfamiliar with the experience. To prepare them for this, we use creative nonfiction to help them articulate the experience of suffering. This allows the advocates to focus directly on the words of survivors, unmediated by the scope of researchers’ survey questions.
Because creative nonfiction allows survivors to speak in their own words, the genre gives us the opportunity to train advocates in aspects of IPV that remain unexamined in popular media. Because depictions of IPV in popular media typically end with the dissolution of the relationship, survivors often have trouble connecting the aftereffects of trauma to issues they may be experiencing. Providing survivors with creative nonfiction by writers who have shared their experiences, and can articulate phenomena that may elude a particular survivor, helps to explain what they may be feeling. In particular, I used the following essays to demonstrate the relationship between IPV and chronic illness, the neurobiology of IPV-related trauma, traumatic brain injury, and the unique challenges faced by LGBTQ survivors of IPV.
Intimate Partner Violence and Chronic Illness
Chronic illness is a prevalent factor in cases of intimate partner violence, both as a risk predictor and a consequence of the abuse itself. Chronically ill women are more likely to be abused, and abused women are more likely to develop chronic illness, such as hypertension or heart disease, asthma, arthritis, and cancer.
A 2002 analysis of the National Violence Against Women Survey (NVAWS) noted that women who suffered physical abuse were 60% more likely to develop a chronic illness. Survivors of psychological abuse, long considered difficult to quantify, were 10% more likely to develop a chronic illness. A 2013 MORE survey found that 81% of women who had experienced abuse had a chronic illness. The survey also found that while women who had never been abused had an average of 1.7 chronic conditions, women who had suffered abuse had an average of 2.7 chronic conditions.
Disabled victims of intimate partner violence are often dependent on their abusers as caregivers, complicating the situation. Jane Eaton Hamilton illustrates this dynamic in “Never Say I Didn’t Bring You Flowers”:
Intimate partner violence is unique in that it creates a condition of dependence, which then interferes with victims attempting to leave the situation. A 2008 survey of Canadian survivors of IPV found that only 5.5% of respondents reported not having some form of chronic pain in their daily lives. 64% of survivors reported back pain, and 63.6% reported frequent (occurring daily or several times per week) headaches. Nearly half reported bowel problems, and almost one in five reported vaginal or pelvic pain. Overall, 35.3% of respondents were classified as experiencing “high disability” pain that “moderately” or “severely” limited their daily activities. The “severely” limited group, 20.9% of respondents, lost a mean of 90 days per year to chronic pain.
Curiously, though 55.8% of respondents reported visiting their family doctor in the last month, with 94.5% of women in the sample reporting chronic pain, they were prescribed opioids for pain relief at a rate no higher the general population, which suggests that women experiencing IPV-related pain are not taken seriously, even by medical professionals. With the lack of attention to this disabling impairment, it’s no surprise that more than half of the women studied were unemployed, which can leave disabled women both physically and financially dependent on their abusers.
Nor is the trauma caused by intimate partner violence always visible. Though the women in the Canadian survey had been out of their abusive relationships for an average of 20 months, 43.4% of survivors reported experiencing memory loss at some point in the last month. Additionally, 69.5% reported difficulty sleeping, and 76% reported fatigue.
Recent work by cellular researchers has found that survivors of intimate partner violence have “significantly shorter” telomeres, a cell component that protects the ends of chromosomes and modulates cellular aging, than never-abused women. In other words, the older an organism is, the shorter its telomeres are. Length of time in abusive relationships, as well as having children within abusive relationships, were highly associated with shortened telomeres.
But though these conditions are chronic, they are not incurable. As Hamilton writes, “It wasn’t until after I left her and I no longer had carpal tunnel, tendonitis, ulnar nerve trouble, and bursitis in my arms that I realized that it hadn’t been computer work causing the pain as she’d said.” A 2015 study found that after three weeks in an intensive meditation retreat, participants had significantly lengthened telomeres.
Intimate Partner Violence and the Neurobiology of Trauma
All three essays in this section deal with the dissociation and posttraumatic stress disorder faced by survivors of intimate partner violence. All three authors make use of short, staccato sentences and single-sentence paragraphs, mimicking the dissociation— the “lack of the normal integration of thoughts, feelings, and experiences into the stream of consciousness and memory”—that often occurs as a longterm effect of IPV.
Kelly Sundberg provides a near-clinical description of her dissociation in “It Will Look Like a Sunset”:
In 1886, French psychologist Pierre Janet documented dissociation as a result of chronic trauma. Though the term had been introduced earlier, Janet was the first to note that it was “the most direct psychological defense against overwhelming traumatic experiences.” However, Janet’s work gradually fell out of favor following the rise of Freud and his disciples. Freud’s student and patient, Helene Deutsch, believed that some women desired to be abused, and that a woman who stayed in an abusive relationship was “enslaved by her masochism, the strongest of all forms of love.” (The issue of women’s purported masochism and their own culpability in abusive relationships continued to be debated in journals of law and psychology, as well as popular outlets like the New York Times, throughout the 1980s.)
Happily, subsequent work in neuroscience has confirmed the view of Janet—that dissociation is fundamentally an adaptation to cope with an ongoing traumatic situation. A 2009 brain-imaging study by Ruth Lanius found that women who had suffered early-life trauma experienced less spontaneous activity in the posterior cingulate cortex, a region of the brain that deals with pain processing and episodic memory retrieval. Further research building on Lanius’ findings has suggested that this inability to process some memories is linked to a subsequent hyperarousal of the amygdala, sometimes called the body’s “alarm system,” a region of the brain responsible for processing fear and attaching emotions to memories.
Summarizing the results, psychiatrist (and Lanius’ former teacher) Bessel van der Kolk writes:
Mandy Rose illustrates Van Der Kolk’s latter point in “On Car Accidents and Second Wives”:
The brain is in a constant state of creating new neuronal connections, especially for any stimuli that might signal danger. As neuroscientist Siegrid Löwel wrote in 1992, “neurons wire together if they fire together.” Rose heard a loud noise in surroundings in which, on multiple occasions, she had been in danger.
An additional complication is that during periods of acute danger, the brain is less likely to form complete memories. Once the amygdala is aroused by danger, it works in conjunction with the pituitary and adrenal glands to flood the body with chemicals to deal with the incipient threat. These chemicals include catecholamines, like dopamine and adrenaline; cortisol, a steroid; oxytocin, which helps maintain a veneer of calm; and opioids, the same painkiller found in heroin, morphine, and Vicodin, though typically in lesser amounts. However, the functioning of both the hippocampus, which is the brain region that encodes and consolidates sensory information into what we typically think of as memories, and the amygdala, which attaches emotions to memories, are easily disrupted by hormonal fluctuations of the exact kind produced by the pituitary and adrenal glands. In that case, the memory remains incomplete, vague, and impressionistic. The feeling of danger may be attached to situations that are not inherently dangerous-- a particular smell or color, or the sensation of being in a moving car. The body, eager to protect itself, reacts to any cue of learned danger, which is exactly what a “trigger” is. In this way, it is easy to understand how a startling noise in a moving car can reduce a person to shaking tears.
Intimate Partner Violence and Traumatic Brain Injury
Susan Grigsby’s “How Could a Man Who Loved Me So Much Want to Kill Me?” deals with an often overlooked aspect of intimate partner violence— strangulation. 56% of women in abusive relationships report having been strangled by their partner. A 2002 study found that 40% of IPV survivors sustained at least one traumatic brain injury (TBI) that knocked them unconscious, and that 92% reported being struck in the head or face. In 2003, Valera and Berenbaum reported that 68% of their sample of abused women had one or more mild traumatic brain injuries, either from blows to the head, or from “anoxic brain injury”—being choked by their partners.
Grigsby captures the dissociation commonly experienced during traumatic experiences: “Even while he had his hands around my throat, cutting off my oxygen, it did not occur to me that he wanted to kill me. It was only as I was losing consciousness that I thought I might die. But even then, my thought was not that he might kill me, but that I might die.”
Traumatic brain injury is a common consequence of intimate partner violence. Yet it is estimated that doctors only correctly diagnose 1 in 35 patients seeking help for IPV-related conditions. For example, medical professionals frequently mistake the symptoms of mild TBI for borderline personality disorder, and incorrectly diagnose survivors. Though a false mental health diagnosis is stigmatizing enough, missing a TBI incurs additional complications. As Martha Banks notes in “Overlooked But Critical: Traumatic brain injury as a consequence of interpersonal violence,” “Sustaining a second brain injury before healing an initial brain trauma has been demonstrated to result in poor memory, poor judgment, inability to perform at the prior level of achievement, and, in the most severe cases, death.”
It is critical that advocates be able to recognize symptoms of traumatic brain injury, such as memory problems, flat affect, and a sudden cessation in therapeutic progress. Grigsby provides a useful description of the acute trauma she suffered: “I couldn't talk for a few days, I assume my larynx was bruised or inflamed, and laryngitis was the excuse I used. Sweaters covered the bruises left by his fingers.” If advocates are able to recognize acute brain injury, they will be able to help their clients seek medical attention sooner, and avoid the chronic problems of untreated TBIs.
Queer Intimate Partner Violence
In 2000, the National Violence Against Women survey found that 7.1% of straight men and 20.4% of straight women reported being the victims of physical abuse by an intimate partner at some point in their lives. However, people on the LGBTQ spectrum are at a unique risk for intimate partner violence. In the same study, 21.5% of gay men and 35.4% of lesbians reported that they had suffered physical abuse from an intimate partner. A 2009 Massachusetts survey found that while 13.6% of the general population had been threatened with physical violence by a partner, so had 34.6% of persons on the trans spectrum.
The reason for this is twofold. Persons on the LGBTQ spectrum, as a sexual minority, face challenges that make them more vulnerable to abuse. LGBTQ people may be less likely to report their victimizations due to fears of outing or discrimination. As a result, nearly 70% of gay and lesbian survivors of domestic violence received no medical care following an attack. Conner Habib writes about this secretive impulse in “If You Ever Did Write About Me, I’d Want It to Be About Love”: “I’m not supposed to tell this story; I should keep it private, I should hold it back. But this story, my story with him, has a life of its own. I know this because it’s still alive.”
Additionally, LGBTQ persons at risk for perpetrating intimate partner violence face stressors that make them more likely to offend. Though empirical literature is sparse, studies have found that minority stressors—“both internalized stressors (e.g., openness/concealment, perceived discrimination, and internalized homophobia) and externalized stressors (e.g., actual experiences of violence, discrimination, and harassment)”—play a significant role in both gay male and lesbian relationships.
These stressors are evident in Jane Eaton Hamilton’s “Never Say I Didn’t Bring You Flowers”:
Additionally, police often refuse to take seriously reports of heterosexual domestic violence, a situation that is worsened when a relationship may challenge their notion of gender roles and heteronormativity. A 2008 study in which researchers accompanied officers to investigate reports of domestic violence produced this anecdote:
Hamilton writes that her claims were not treated seriously due to these prejudices, and confronts this dynamic:
Additionally, according to the National Center for Women and Policing, while 10% of population may experienced family violence, 40% of law enforcement families do. This may be why law enforcement is incapable of dealing with intimate partner violence-- chances are good that they’ve done worse to their own partners.
Creative nonfiction offers us the chance to hear survivors of intimate partner violence in their own words, unmediated by the study designs of academic research. This is tremendously useful in the training of direct-service professionals or volunteers. Asking survivors to help train new advocates can be a burden on the survivors themselves, while having trainees accompany advocates on calls can change the dynamic in advocate-victim interactions and entail privacy concerns. Creative nonfiction offers an option that involves none of these risks and can be easily pursued by programs with limited resources.
Click here to download a printable PDF with Works Cited.
Christian Exoo & Sydney Fallone
Using CNF to Teach the Realities of Sexual Assault to First Responders: An Annotated Bibliography
Teachin' BAE: A New Reclamation of Research and Critical Thought