HealthLeader

An Online Wellness Magazine produced by The University of Texas Health Science Center at Houston (UTHealth)

Sleeping with the Enemy

Your worst day may be the first day you start saving your life

Young woman walking down the center line of a rural road carrying a suitcase.

She did everything right. Everything.

When her husband’s behavior took a menacing turn, she recorded his conversations as proof. When he began abusing her verbally, she slept in another room. When the abuse turned physical, she filled out a restraining order, filed for divorce and moved. She told no one but her parents and cousin her new address. She alerted her school’s police department, entered their protection program, and checked in multiple times a day with the few persons who knew her schedule and her secret.

Finally, when his phone calls turned threatening, she entered a women’s shelter. She did everything right.

She never saw it coming.

On a hot August day in 2007, Mina Rosenthal-Eames, a student at The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry, exited a bus to her off-campus parked car. As the bus pulled away, she was ambushed by her estranged husband who had been tracking her in a rental car. He shot her point-blank six times; she was dead by the second shot.

Her court date to finalize her divorce was scheduled for the next morning.

Reality check

For victims of intimate partner violence, the abuse doesn’t end when the marriage, the commitment or the dating ends. It doesn’t end when the victim finally works up the courage to get out. In fact, the most vulnerable time for a victim is at the point of departure.

“For a victim of domestic abuse, the risk of partner homicide increases significantly when that victim leaves,” says emergency medicine nurse practitioner Elda Ramirez, PhD, who also is trained in forensics to spot and diagnose domestic violence injuries.

Though each case is as unique as the destructive relationship itself, common threads weave through each story. Identifying them, though, is tricky. Myths abound. Misconceptions need addressing.

We will leave the instructions and resources for actual plans of escape to the experts who work in the trenches and have success stories to back them up. For now, educate yourself and empower your loved ones by separating myth from fact.

MYTH: ‘She should have seen it coming...we sure did...’

Monday-morning quarterbacking is pointless. We all saw it coming—after it came. What begins as expressions of protection, adoration, romantic desires to have someone all to themselves slowly metamorphoses into control, possessiveness and runaway jealousy. Without a dossier or a history of violence, how does one see it coming?

Lulled into trust and vows of unconditional love, we often miss the red flags. “An abuser does not see you as his love, as a person with rights, boundaries and inherent freedoms. He sees you as a possession, to be owned and controlled through threats, physical violence and/or manipulated through verbal putdowns, humiliation, emotional hostage-taking,” says Ramirez.

“If you do not view life through those lenses of control and manipulation, you may not even recognize it as such. You may simply believe him to be right,” she says. And, if you grew up in a controlling environment, you may not see his behavior as dysfunctional—just familiar, Ramirez warns.

In many cases, intimate partner violence begins years before as a seed—a comment, a look, a raised eyebrow, followed by an apology, heartfelt—with a loophole. I didn’t mean to say that, really. Forgive me. But, Honey, you did bring it on yourself...

Patterns emerge in relationships that don’t begin with broken ribs. Escalation is incremental and almost always involves a cycle of abuse and apology. The abuse gets worse; the apologies, bigger. The apology may even be sincere—as sincere as the abuse. We choose to hold on to the apology, change our behavior just enough to thwart the next abusive episode. In fact, we’re sure it’ll never happen again—he promised.

By the time we’re paralyzed with terror, we can’t even remember the word, the look, the offense that triggered it—much less the day it all began.

No, we didn’t see it coming. And neither did our friends, family or co-workers. In fact, they thought he was charming.

MYTH: ‘She could always just leave. No one’s making her stay.’

There are 100 reasons to stay and only one reason to leave: unimpeded, abuse always escalates, Ramirez says.

“People stay initially because they took vows. They believe it will never happen again. They are ashamed that they’ve made a mistake. They want to protect their partner from the law, society, public judgment,” she explains.

People stay for religious reasons, they stay for the children. They stay for the unborn child whose birth, they are sure, will end this bad stretch in their relationship.

By the time the abuser has pummeled the victim emotionally or physically, they also have pummeled them financially—they can’t afford to leave, literally. They stay because they begin to believe that the abuser is correct: Who would want you? Without me, you’re nothing.

They stay because they feel they’ve waited too long to come forward—their credibility is blown. They stay for fear he will take the children, like he’s threatened many times before. “Much in the justice system with regard to domestic abuse has changed just in recent decades,” Ramirez reminds. “It wasn’t that long ago that abuse was viewed by law enforcement as a family issue to be resolved privately, not by police or the justice system,” she says. And now the courts are overtaxed by the very systems put in place to protect domestic violence victims.

They stay because they can’t imagine going into a shelter, or a safe house, turning their lives and their children’s upside down just to get away, Ramirez says. “But, anyone dealing with that kind of tyranny already is living upside down. Their lives are so extreme, only extreme measures will work.”

They stay because computers are monitored, car keys taken, bank accounts frozen, friends cut off. They stay because the abuser wears a clergy collar, a badge or holds dual citizenship with a country that would not readily give up the children, if he leaves with them.

Finally, they stay because they have good reason to believe the threat: if you leave, I will hunt you down, wherever you are, for as long as it takes. If I can’t have you, nobody will.

MYTH: This always seems to happen to those people.

Which people? The ones in the Fortune 500? Or the ones coaching our children’s Little League games?

Intimate partner violence is not confined to a marriage. It is not confined to heterosexual unions or even to adult relationships. Nor is it a tragic aberration that occurs only in “certain neighborhoods” among “certain colors” of “certain economic circumstances.”

Like tornados, abusive relationships are equal-opportunity disasters. They cut a swath of destruction across all social, ethnic, educational and economic strata.

Even though women far outnumber men as victims of abuse and domestic violence that leads to murder, men die as well. According to the American Bar Association’s Commission on Domestic & Sexual Violence:

  • Annually, about 1.3 million women and 835,000 men are physically assaulted by an intimate partner in the U.S.

  • In 2000, 1,247 women and 440 men were killed by an intimate partner.

  • In recent years, an intimate partner killed about 33 percent of female murder victims and 4 percent of male murder victims.

According to the US Department of Justice, between 1998-2002

  • Of the 3.5 million violent crimes committed against family members, almost half were crimes against spouses.

  • Female spouses accounted for 84 percent of victims.

  • Female victims of dating violence totaled 86 percent.

  • Males made up 83 percent of spouse murderers

  • and 75 percent of dating partner murderers.

Intimate partner violence among 18 to 24-year-olds is sobering. From the same study above: although this age group made up only 11.7 percent of the population, 42 percent of the victims of violence suffered it at the hands of a boyfriend or girlfriend.

MYTH: ‘Well, it’s not like he hits me...’

Abuse comes camouflaged sometimes, often in sexual packaging. “What better control over an intimate partner than foisting sexual relations? Remember, rape is not a crime of passion, it’s a crime of violence and control,” Ramirez says.

In eight out of 10 rape cases, the victim knows the perpetrator. Of those who reported sexual violence, 64 percent of women and 16 percent of men were “raped, physically assaulted or stalked by an intimate partner”—defined as a current or former spouse, cohabitating partner, boy or girlfriend, or date. (Findings from the National Violence Against Women Survey, 2000)

The velvet hammer of verbal and psychological abuse is harder to identify, document—and prosecute. Like the old organized crime technique—beating an enemy with a bag of oranges—internal damage can be fatal, without a single external bruise.

Threats of retaliation against simple mistakes (spilling the soup), public humiliation, irrational accusations, incessant sarcastic barbs meant to belittle all work their way into the storyline of a relationship. It is abuse of the invisible kind.

MYTH: ‘No one would believe me anyway.’

Emergency room personnel are gifted at two things: spotting cover-up stories about wounds and using the wounds to spot the cover-up stories. When a woman comes to an ER with blunt trauma to the jaw and fingerprint bruises on her neck, chances are she didn’t trip over the garden hose.

“The abuser usually won’t leave the victim’s side for fear she’ll tell the truth,” Ramirez says. “We have all sorts of ways to separate the couple long enough to convey the message to the victim that we can get her help.”

Once a possible victim of abuse enters the ER, all sorts of wheels start turning among the ER staff. “First the team decides if the injury correlates to the story. If the victim is hesitant, in an emotional state and can be separated from his or her abuser, the first question is simple: ‘Do you feel safe at home?’” Ramirez says.

They also watch the interplay between the victim and the rescuing friend who may have brought her in. “We see the friend whisper into the victim’s ear, ‘Tell them what really happened...’”

Ramirez ticks off a list of questions she and her team are trained to ask and answers they’re trained to read between the lines or between gritted teeth.

“We give them every opportunity—overtly, covertly—to tell us they need help. Frankly, sometimes it just doesn’t work,” Ramirez says. “They come in repeatedly, each time denying the abuse. Then, we read about them in the headlines. It tears us apart.”

Victims are adept at covering for their abusers—and by extension, themselves. Even if society has moved proactively toward advocacy of the abused, there still lurks a shadow-attitude of blame and shame toward the victim.

FACT: Red flags are everywhere, just look.

Respecting your ‘No.’

No one enters a relationship with expectations so low that “at least I got out alive” is the measure of its success. Respect is earned over time, even in the blush of love.

The first question therapists often ask women in new relationships is, “Can he hear your ‘no’?” In other words, are you respected as a living, breathing, human being?

Trust should come slowly—in the best of relationships. With any relationship, the first thing one should ask herself is "Does he respect my boundaries? Does he argue with me, try to convince me, not take my needs into account, especially if they involve being with other friends instead of him that night. Can he hear me when I choose alone-time? Can he hear my ‘no’?”

When you find someone who respectfully and cheerfully honors your right to say no—from the mundane (sitting through a ball game) to the intimate (having sex)—that person is showing respect for you. And that is the early budding of trust.

“If he can’t observe your boundaries, you can never be safe,” Ramirez warns.

Need to control, manipulate, possess

What first feels like care and concern—constant phoning or texting to see where you are—begins to feel like a monitoring system. If you have to account for every moment between the time you left the office to the time you walked through the back door, ask yourself if this feels good.

If each time you enter a restaurant or party, your casual sweep of the room with your eyes turns into an accusation of flirting, take note.

Does your partner have unrealistic expectations of your dress, behavior, domestic responsibilities? Does your partner find ways to separate you from your “prior life” by isolating you from your friends and family? Do you find that you distance yourself from loved ones because you’re in fear of his reaction?

When things go wrong, is it always someone else’s fault, particularly yours? How does he make you pay for it?

The Texas Council on Family Violence lists other signs of family violence:

  • Whirlwind romances and instant swearing of monogamy on your part

  • Threats of violence against you and others

  • Use of weapons or recent purchase of one

  • Dependency on you for all emotional and physical needs

  • Use of force during an argument

  • Hypersensitivity or exaggerated reactions

  • Cruelty to animals or children

  • Striking or breaking objects

  • Forced sex

  • Verbal attacks

  • Jekyll/Hyde behavior

  • History of violence or battering

  • Substance abuse

  • History of mental illness

FACT: “It wasn’t the worst beating, but it was the last.”

“Leaving requires that a victim be ready. Something shifts, and it’s as if the victim decides that today might not have been the worst time, but it will be the last time.” Ramirez says.

“Today” is not the day to leave; it is the first day to begin the careful plan. The most dangerous moment for a victim is when she shows resolute conviction. “A partner leaving is the ultimate loss of control,” Ramirez says. The abuser will try anything to regain his hold.

Start hoarding cash, getting all financial paperwork and private documents in order and off-site. Pack clothing, necessities and again, place them somewhere accessible, but off-site from your home. Wipe out numbers on your cell phone to shelters or to the police. Use email with great care in your home. Get a free and blind email box, using a fake name as part of your address.

Gather evidence of abuse by keeping a journal with dates and taking photos of injuries with dates. If possible, come clean to a few trusted family members, friends or co-workers, so that someone else can verify the abuse to authorities when the time comes to enlist legal support.

Then wait until you have a professionally-assisted plan with the aid of a shelter, safe house or agency.

Do your research safely

If you have Internet access, you will notice that repeated reminders pop up on the screen on numerous domestic violence resource Web sites to remind you that the computer you’re using may be monitored by your abuser. Use the ESCAPE button if you must exit the system quickly. Wipe out your surfing history once you are finished and look around you while you are researching.

And now, let the experts take over. This is a start: Click on the links below.

Houston Resources:

National Resources:

For UTHealth and MD Anderson employees, staff and students:
Victims of domestic and workplace strife, call: 713-792-2890.

For emergencies, call 911.