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
- 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
"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 ."