How to talk to an abused friend

I cringe when I think back to how I used to talk to domestic violence victims. I was a newly qualified doctor. At 26 years of age, I was dealing with life and death on a daily basis, long before I had any real-life experience.

Such was the clarity of my convictions when I met my first battered woman in the emergency room. Her drunken husband had broken her jaw. “You must leave him,” I said. “Mm,” she said. “One woman dies every eight hours at the hands of her partner. He might kill you if you stay, ” I said, convinced that the rationality of statistics would make her see sense. She just glazed over and looked far away. The conversation, such as it was, was over.

Working as an intern in an emergency room quickly teaches you that not everybody in life has options. That a woman might stay with an abusive man because otherwise, she can’t feed her kids.

So the next time I met an abused woman, I felt that I was ready. I referred her to NGO’s to provide counselling. I gave her the number for a shelter. We had a long chat where I voiced my concerns for my beaten patient and educated her about some options. I was trying hard to be a good doctor.

I was caught off guard when she came to the emergency room looking for me the next time her husband was in a rage. I organised for a taxi (those were the days before Uber) to take her to a shelter. I gave her some money. I stood firm when her angry husband came to the hospital looking for her. I did not disclose her location; I called security.

So imagine my surprise when she was back, broken and bruised, in the emergency room a month later. She was back with her husband, back to being beaten again. I felt let down, angry and confused. I attended to her injuries without engaging her in conversation. We did not make eye contact.

My career as a psychiatrist has given me many opportunities to learn. I have learnt to listen more than I speak. The victims of domestic violence have taught me:

• Women are not the only victims. Men can just as certainly be victims of domestic violence: from their homosexual partners, but also from the heterosexual women in their lives. Sometimes he might be much bigger than the abuser, but there is still a power differential. Because simply put,  they are not as mean as their abusive wives. (For this blog I will refer to women as the abused, but I could as easily have referred to men.)

• The abused knows something about the abuser which we don’t. When she says that she is afraid to leave because he might kill her, she may well be right. Of the murders committed by intimate partners, 70% occur after she has left.

• “I still love him” is one of the most common reasons a woman gives for still staying with her abuser. It might seem counter-intuitive, but remember, after a violent episode the abuser is often very, very sorry. They are trying hard to actively seduce their partner again. A disjunction happens between the man who hurt her and the man who loves her. If the abuser is a gifted manipulator, they can even make their victims feel as if they are at least partially responsible for the violence. That they “pushed them” to it.
• Vulnerable women, who are financially dependent, are at risk. They feel that they won’t be able to provide for their children or survive on their own. Strong, educated women in good jobs are at risk. They feel that this is their problem, they are too ashamed to ask for help. Domestic violence is very non-discriminatory.
• You cannot “rescue” a woman from a situation of spousal abuse. A well-meaning rescuer can come across as just another form of control. The victim must figure it out and rescue herself.

That’s not to say you can’t and should not help. Your help can literally save a life. Many of the survivors in my practice humbly say: “I would not have made it if it wasn’t for the help from my friends.” Think less about rescuing and more about empowering.

So what can you do? Start the conversation by being affirming. Tell them what you like about them; then ask questions and listen, without judgement, to the answers. Something along the lines of “You have such a sweet smile, but I don’t see it much anymore. I do see a lot of bruises. I want to listen if you want to talk.” Give the message that they are worthy to be cared about.

If you manage to get the abused talking, you are already helping. The silence is broken and with it some of the abuser’s power which thrives on silencing and shaming. Another of the abuser’s tactics is isolating the abused from their family and friends. If you can become a friend, you could also help her link to networks.

Be patient. Self-empowerment takes time. Your role can be to do what you can to enhance safety. Brainstorm with her: does she need a cell phone with an Uber account loaded? Can you keep spare clothes, spare keys for her at your place? Does she go to a doctor to document the abuse?

Domestic violence is a complicated and dangerous issue. You do not have to be the expert. Don’t offer more than you can deliver. But don’t turn away from it either. Society turns a blind eye and too often ends up colluding with the abuse. With love and support, the victims of domestic violence do find the strength to leave. And then the strength to rebuild themselves. Sometimes, all they need is a friend.

Help and Resources in South Africa:

• www.powa.co.za (People opposed to women abuse)
• www.tears.co.za
• Tollfree helpline 0800 150 150
• Facebook page: Get Up, Woman