Stanford School of Medicine
Domestic Abuse–

Why Doesn't She Leave?

One of the most difficult sources of frustration for healthcare personnel is that if abuse causes so many far-reaching problems, why doesn't s/he just leave? This is also one of the largest sources of shame and subsequent non-disclosure for patients.

Reasons patients don't leave are many and complicated. Some of these are:

  • not recognizing their situation as abuse
  • denial
  • intense religious or cultural pressure to "make the marriage work"
  • love, pity, sympathy for what they think the abuser could be/has been in the past
  • immigration issues, language barrier
  • threat of "outing" in homosexual couples
  • lack of economic options (skills, education to support self and kids)
  • economic abuse with lack of access to funds, accounts, credit rating destroyed
  • sabotage of job, school
  • embarrassment, shame, humiliation that they have found themselves in this situation - often insidious over time
  • have been isolated by abuser; lack of support system; thinks no one cares
  • psychological abuse may lead to feelings of worthlessness, helplessness; that the abuse is her/his fault
  • depression, anxiety, PTSD may cause disproportionate fear as well as decreased decision-making ability
  • realistic fear that leaving will agggravate the violence
  • lack of trust in others e.g. police to keep them safe
  • threats to patient of harm to her/him or anyone who helps
  • fear of custody concerns or removal to foster care
  • threats of kidnapping or physical harm to children
  • physical or sexual violence
  • choking to unconsciousness may cause traumatic brain injury with decreased executive function

 
experiences

"My father hit my mother and me, and my husband hits me. I thought all women got beaten and simply never talked about it."
--- software company secretary from India

"My husband said 'You think you're going to leave me?' and then, in front of the kids, picked up our cat and broke its neck. I looked into his eyes and knew he would kill me. "
--- middle school teacher, mother of three

"The ones who are the most embarrassed are the ones who say 'I have a degree from Harvard. I make $300,000 a year. How did this happen to me?' They don't call back or come in because they are so ashamed."
--- local shelter coordinator

"I was so depressed and tired that it was all I could do to drag myself through the day and take care of my children, let alone have the energy to make a plan to leave ."
---abused homemaker

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