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Domestic Violence and Mental Health: An Issue of Immense Concern

Jul 23 2023 / Posted in Gender Violence

- By Mahima Trivedi, Rama Sridhar and Nikhat Shaikh

Domestic violence refers to “any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women.” (United Nations General Assembly, 1993)1

Domestic violence is one of the most widespread yet reticent issues not only in India but all over the world. In India, however, we see unique manifestations of gender-based violence. We see stories of violence like the recent wrestlers’ protests or the Shraddha Walkar case coming to the limelight, as they should. Many forms of daily violence are normalised under the garb of patriarchy and culture. “Aurat hain toh thoda sehena padta hain” and “unke ghar ke maamle main hum kya kar sakhte hain” are frequent sentences we hear.

At a fundamental level, gender-based violence manifests historically unequal power relations between men and women, and it plays out as complex patterns of behaviour, leaving behind deep-rooted physical and psychological scars. These scars largely remain hidden, and if unresolved, they may even escalate with the passing of time. If we can delve deep within ourselves, there are many instances and scenes that flash in front of our eyes, be it an overt act of aggression or a furtive gesture or a raised voice, pointing towards an unequal power dominance within the family and abuse occurring within this space.

As early as 1993, World Bank had identified domestic violence as a major contributor to the global burden of ill health in terms of female morbidity and mortality, leading to psychological trauma and depression, injuries, sexually transmitted diseases, suicide and even murder.2 However, the hard reality is that data does not reflect this stance and provides a bleak picture. Globally, 1 in 3 women have been subjected to either physical and/or sexual intimate partner violence or non-partner sexual violence in their lifetime (WHO 2020).3 In India, NFHS 5 data reports that 29 % of women aged 18-49 years have experienced physical violence since the age of 15 years. 32% of ever-married women aged 18-49 years have experienced physical, sexual or emotional spousal violence.4 So indeed, domestic violence is a huge concern and requires intervention at multiple levels.

Why is it a reticent issue?

A distressing aspect of domestic violence is that it can manifest as a physical act or mental abuse, or sexual violence and is often initiated by an intimate partner. Other perpetrators may include fathers, mothers-in-law, and other family members.5 Given that violence is occurring within the supposedly ‘safe space’ of the household and within relationships that fall under the purview of familial ties, it becomes extremely challenging for the survivors to speak out and for the family to acknowledge and take punitive action against this abuse.

In our experience of working with the survivors of domestic violence, we have observed that they may experience feelings of shame, guilt, numbness, or inability to comprehend what has happened to them. Embarrassment, even fear of repetition or escalation of these acts of violence, may contribute to hushing up of the abuse, and the survivors are often referred to as ‘silent victims.’

So how are these silent victims affected?

Being assaulted or abused by someone who is a loved one, be it a partner or father or close relative, and thus trusted at a very primal level can be very damaging. Physical scars are evident. However, the emotional and psychological repercussions can leave behind adverse outcomes on the survivor’s mental health. Studies have pointed to negative and long-term consequences such as behavioural problems, sleeping and eating disorders, depression, anxiety, post-traumatic stress disorder (PTSD), self-harm, and suicidal ideation.6

Given our experience of intervention with these survivors, their self-confidence takes a deep dive as they find themselves in a position where they are not able to speak out about this form of abuse. They often blame themselves for the situation in which they find themselves, and ruminative thoughts of what they should or could have done may run continuously in their minds. The survivors feel their action has initiated the response of abuse, and they are themselves to be blamed. They say, “sab meri hi galti hai, agar me khana thik se banati, toh yeh nahi hota.”

So how are survivors of domestic violence dealing with the issue?

With growing awareness campaigns and global actions including Sustainable Development Goal 5 (Achieving gender equality and empowering all women and girls) there are many agencies, both governmental and non-governmental organisations working to place the dignity of women and children on priority. Resources have been allocated to public systems and private agencies to work on this issue and provide support to the survivors. However, SNEHA’s work in the communities reveals that gender-based violence is still considered a family issue and something to be dealt with privately by the survivors. The public systems such as legal support, counselling services, livelihood, etc. Continue to be out of reach of these survivors who struggle to come out of this endless cycle of abuse.

It is in this space that SNEHA’s programme ‘Prevention of Violence against Women & Children is working with communities as well as public systems to work on this issue at multiple levels - ranging from individual to community to institution and up to policy level.

The SNEHA team believes that survivors of violence require multi-layered support and strive to improve their agency and well-being by providing timely counselling and mental health services. Our volunteer groups - Sanginis (women volunteers) and Mitras (men volunteers), are trained to identify and refer cases to Counselling centres where a team of mental health and legal professionals provide systemic support to the survivor. The team works holistically to provide a way ahead for these survivors who have the courage to attempt to come out of the abusive relationship.

Rukhsana(name changed) a young mother of three, suffered through seven years of escalating abuse in her marriage. Violence ranged from hurtful words to physical violence. She came to SNEHA and met the counsellor who referred her to a Clinical Psychologist. She was soon diagnosed with moderate depression on the Beck’s Depression inventory (BDI) scale. The psychologist began relaxation therapy and assertiveness training. SNEHA also supported her livelihood through enrolling her in nursing training. Her husband, realizing the loss of control, sought reconciliation. However, Rukhsana's focus had shifted to her children and her future now. With support from SNEHA’s legal team, she filed for divorce and fought for custody. Her story is a testament to the resilience of survivors who refuse to be silenced.

Aisha (name changed), a resilient mother suffered through 16 years of domestic violence from her husband and in-laws, on grounds of dowry demands. She did not receive any support from her natal home and she reached out to SNEHA. Assessing the severity of her trauma and depression, the counsellor immediately referred her to the Clinical Psychologist. Aisha was diagnosed with Post Traumatic Stress Disorder (PTSD). Through Eye Movement Desensitization and Reprocessing (EMDR), a method used for the treatment of the disorder, Aisha began her healing journey. The clinical psychologist provided a safe space for her to process her experiences and rebuild her shattered sense of self. With each session, Aisha regained her strength and learned effective coping mechanisms to resolve her emotional turmoil.

The other major ‘invisible survivors’ are children who are exposed to or may be directly experiencing violence at home. Studies have reported that these children may have trouble at school and are at higher risk of substance abuse, aggression and other mental health concerns. Work with the survivors has to include intervention with family members, including children.

Ravi, a witness to daily violence at home, struggled academically and started to use drugs and aggression as a coping mechanism. A referral led him to SNEHA’s clinical psychologist, who used Motivational Enhancement Therapy (MET) and trauma-focused approaches to help Ravi challenge negative thoughts, develop coping strategies, and process his trauma. Gradually, positive changes emerged, resulting in healthier anger management and a stronger sense of self.

Domestic violence occurs across geographies, religions, class, and caste. Women in abusive relationships find it difficult to leave, fearing that their life could get worse if they do; the perpetrator may become even more violent, and concerns about their children’s upbringing, institutional responses to violence, and lack of resources to live independently. Another factor we have seen that compounds this is the ‘cycle of violence and hope for change’. Most perpetrators often exhibit a behavioural pattern of remorse after inflicting violence and a promise that they will change before the cycle of violence begins again.

The first step in breaking this cycle is recognition that ‘violence of any form is not normal’ and ‘violence of any form is not okay’. In fact, all forms of violence, including verbal abuse, are illegal under the Protection of Women from Domestic Violence Act 2005. The bottom line is that the violence has to stop, whether the woman chooses to continue living with the partner or not. Therefore, if you or anyone you know is experiencing any form of violence, call our 24x7 One Stop Centre helpline on 022-24100511.

Once the violence has stopped, some measures that we can practice to promote mental health and mitigate adverse outcomes of this form of abuse include:

Speaking with mental health professionals: As we have seen from the aforementioned case studies, mental health professionals such as counsellors and clinical Psychologists are trained to support survivors and family members to deal with and resolve this form of abuse using various therapeutic interventions.

Relaxation techniques: Practising relaxation techniques help in moving away from reactive behaviours and moving towards mindfulness and the promotion of well-being. Some useful techniques include progressive relaxation of different muscle groups using imagery or breathing exercises, guided imagery, and deep breathing exercises. 

Taking care of physical health:  It is important to make time for self-care practices as studies have repeatedly shown an interconnection of physical, mental, emotional, and spiritual health.

Prioritize regular exercise and overall fitness.

Nourish your body and focus on a balanced diet.

Get sufficient sleep and create a calming environment to promote quality rest and rejuvenation.

Practice self-care by dedicating time to relax.

Stay hydrated and maintain optimal health.

Seek medical care and address any health concerns promptly.

Limit substance use as it can have detrimental effects on physical health.

Take breaks and listen to your body's signals and recover when needed.

Set realistic goals and celebrate achievements along the way.

Being connected: Maintaining bonds with family members, friends, community members, colleagues is very essential as they can be one’s greatest support system in times of need. The survivors need to guard against self-isolation and strive towards maintaining connectivity with other people within their social circle. Having social support is critical in coping with challenging situations, improving self-esteem, and managing stress.

Practicing gratitude: When one is consciously grateful for the good things in life such as the presence of loved ones, having a source of livelihood/ job, good friends network to name a few things, it can help one to move away from tunnel vision and view life from a different perspective. It can enable one to feel positive emotions, relive good memories, improve mental health, and work towards developing good coping mechanisms.  

In conclusion, it is essential to recognise and address the mental health impact of domestic violence and take steps to move towards healing and recovery. If you have experienced abuse of this kind or know of someone going through this trauma, do reach out for support. It is very important that each one of us takes a stance to open the discourse on this concern and do our bit, as violence in any form cannot be tolerated. 

Supporting the mental health of survivors of domestic violence with dignity and pride remains our motto. 

1 United Nations Declaration on the elimination of violence against women. New York: United Nations General Assembly, 1993

2 The World Bank. World Development Report: Investing in health. New York: Oxford University Press; 1993

3 https://www.who.int/news-room/fact-sheets/detail/violence-against-women

4 National Family Health Survey (NFHS-5), 2019-21. India Report. GOI

5 Garcia-Moreno C, Jansen HAFM, Ellsberg M, Heise L, Watts C. WHO multi-country study on women’s health and domestic violence against women: Initial results on prevalence, health outcomes and women’s responses. Geneva: World Health Organization; 2005

6 Sharma KK, Vatsa M, Kalaivani M, Bhardwaj D. mental health effects of domestic violence against women in Delhi: A community-based study. J Family Med Prim Care 2019;8:2522-7