Helping patients bring an end to domestic violence

 

As healers trained to address some of the psychosocial issues facing our patients, we need to understand various forms of domestic violence – and what we can do to stop it. One form, honor killings, remains pervasive across the globe.

In a sample of 856 ninth-grade students from 14 schools in Amman, Jordan, for example, about 40% of boys and 20% of girls believed that killing a daughter, sister, or wife who had dishonored the family was justified (Aggress Behav. 2013 Sep-Oct;39[5]:405-17). The schools were representative of students from different religions, socioeconomic statuses, and upbringings. The proportions are broadly in line with the religious affiliation of Jordanians, with 92% of the population identifying themselves as Muslims, 6% as Christians, and 2% as affiliated with other religions.1 However, researchers found that support for honor killings was more widespread among adolescents from poorer and more traditional family backgrounds.

Those findings are in accord with those from studies on related topics such as wife beating, which also is more prevalent among the less educated and traditional groups of Middle Eastern societies. However, neither religion nor the intensity of religious beliefs was a significant predictor of attitudes toward honor crimes. This supports the theory that honor killings do not depend on a specific religious background; rather, they depend upon patriarchy, family honor, and the preservation of female virginity as prominent values. Jordan is considered modern by Middle Eastern standards, so the high proportion of young people with supportive attitudes about honor killing is concerning.

What are honor killings?

According to Sally Elakkary, MD, and her colleagues, honor killings are “violence implicated against a female for the deviancy of her activities from the traditional cultural norms.”2 The perpetrators in these crimes are usually male relatives but may be other family members, including women. Males also can be victims of honor crimes. For example, a male can become a victim if he is the female’s lover in an extramarital relationship or if he is homosexual.

Most honor killings are reported from countries in the Maghreb region of North Africa; the Middle East (Palestine, Lebanon, Syria, Jordan, and Turkey); and Western and Central Asia (Iraq, Pakistan, Afghanistan, and India). However, honor killings also occur in countries with strong minorities from those origins. A report3 published in 2000 by the United Nations Population Fund estimated that 5,000 honor killings were carried out worldwide per year, with the largest absolute numbers reported for Pakistan and India (about 1,000 cases per year in each country).

Until the 1960s in the United States, penal codes in some states, such as Georgia, New Mexico, Texas, and Utah, justified a husband killing his wife’s lover. In those states, the law was formulated to protect the male’s honor. Honor killings are culture-based practices that are supported indirectly by that country’s legal system. In a recent New York Times op-ed4 piece, Bina Shah stated that “upending misogynistic tribal codes is the real key to finally ending the most egregious gender crime.” The Pakistan Parliament recently stiffened the punishment for honor killings. The new anti–honor killing law mandates a minimum lifetime jail sentence for perpetrators and closes a legal loophole that allowed an honor killer to walk free if the family of the victim forgave him.

However, in rural areas, a Pakistani woman accused of violating family or tribal honor can be sentenced to death by an informal village court or a gathering of tribal elders. Women have been killed by stoning, shooting, or being buried alive. Sometimes, the woman’s relatives condemn her to death without a trial. Women are killed for reasons such as wanting to marry of their own choice, divorcing abusive husbands, or speaking to a man or boy outside the family; “in one case, four young girls who were filmed dancing in a rain shower were executed by their cousin for immorality,” Ms. Shah said.

Range of behaviors

Abusive behavior can take many forms, including:

• Isolating a person from her friends and family.

• Depriving her of basic needs.

• Monitoring her time.

• Monitoring her use of online communication tools or spyware.

• Taking control over aspects of her everyday life, such as where she can go, whom she can see, what she can wear, and when she can sleep.

• Depriving her of access to support services, such as specialist support or medical services.

• Repeatedly putting her down, such as telling her that she is worthless.

• Enforcing rules and activities that humiliate, degrade, or dehumanize the victim.

• Forcing the victim to take part in criminal activity such as shoplifting, and neglecting or abusing children to encourage self-blame and prevent disclosure to authorities.

• Abusing finances, including controlling resources so that the person is allowed only a punitive allowance.

• Threatening to hurt or kill her.

• Threatening a child.

• Threatening to reveal or publish private information (for example, threatening to “out” someone).

• Assaulting the person.

• Causing criminal damage (such as destruction of household goods).

• Engaging in rape.

• Preventing a person from having access to transportation or from working.

 

New domestic violence law in the United Kingdom

Meanwhile, domestic violence laws in England and Wales now consider emotional and psychological abuse as legally actionable. The new legislation targets those who subject spouses, partners, and family members to psychological and emotional torment, but stop short of violence. The new law5 follows a Home Office consultation showing that 85% of participants said the existing law did not provide sufficient protection and a Citizens Advice report showing a 24% rise in people seeking advice for domestic abuse.

The new law falls under the Serious Crime Act 2015 of England and Wales. The act creates a new offense of “controlling or coercive behavior in intimate or familial relationships.” The act states: “The new offence closes a gap in the law around patterns of controlling or coercive behavior in an ongoing relationship between intimate partners or family members.”

Breaking the law carries a maximum sentence of 5 years’ imprisonment, a fine, or both. The behavior must have had a “serious effect” on the victim, meaning that it has caused the victim to fear violence will be used against them on “at least two occasions,” or it has had a “substantial adverse effect on the victim’s day to day activities.”

The alleged perpetrator must have known that his behavior would have a serious effect on the victim, or the behavior must have been such that he “ought to have known” it would have that effect.

The new law includes honor-based violence, female genital mutilation, and forced marriage. The law explicitly states that the victim may fear that the perpetrator has asked another person to commit violence against them, thus including family honor killings.

Gendered nature of domestic controlling or coercive behavior

While all legislation is gender neutral, women and girls are disproportionately affected by crimes of domestic violence and abuse. Women from black and minority ethnic backgrounds may experience barriers to reporting, such as a distrust of the police, concerns about racism, language barriers, concerns about family finding out, or fear of rejection by the wider community. A victim might be fearful about her children being taken away if she makes a report. Lesbian, gay, bisexual, and transgender individuals in relationships may be subjected to threats to reveal sexual orientation to family or others.

Interestingly, the U.K. guidelines state that victims of controlling or coercive behavior may not recognize themselves as victims. Therefore, it is important that the new offense be considered by the police and other authorities in attendance at all call-outs. Police are encouraged to ask questions about rules, decision making, norms, and fear in the relationship, rather than just what happened. The guidelines provide specific comments about handling perpetrators who are described as being “particularly adept” at manipulating professionals, agencies, and systems, and may use a range of tactics in relation to this offense, including targeting people who might be vulnerable (there may be evidence of this from previous relationships) and using the system against the victim by making false or vexatious allegations to agencies.

The Authorized Professional Practice on Investigating Domestic Abuse issued by the College of Policing states: “A manipulative perpetrator may be trying to draw the police into colluding with their coercive control of the victim. Police officers must avoid playing into the primary perpetrator’s hands and take account of all available evidence when making the decision to arrest.” Such evidence includes attempting to frustrate or interfere with the police investigation; making counterallegations against the victim; and using threats of manipulation against the victim – such as telling the victim that he will make a counterallegation against her, that the victim will not be believed by the police or other agencies, that he will inform social services, or that he will inform immigration officials where the victim does not have a right to remain.

How can psychiatrists raise awareness?

• Individual change. Abusive controlling behavior can have its origin in childhood psychological experiences, in the same way that honor killings and wife beating can have their roots in the perpetrator’s cultural experience. As a child, the adult perpetrator may have been a direct victim of violence or may have been a witness to domestic violence. Controlling abusive behavior also can occur as a choice in perpetrators with personality disorders unrelated to childhood experiences. It can occur in a person with both exposure and personality disorder. It is important to understand the origins and reasoning behind the behavior in order to understand how best to intervene.

If the behavior is based on the childhood experience of the prevailing sociocultural practice, the psychiatrist can explore values and beliefs, identifying those that are based on family and cultural factors. Beliefs that have been present during a person’s entire life can appear as the unexamined “background” of their lives. Bringing those beliefs to the fore can allow discussion. For example, does the individual hold the belief that women are possessions? What is the basis of holding such a belief? How does he account for the differences between societies?

 

• Family change. Individuals in the family may differ in their support of honor killings. Those who do not support honor killings may have difficulty speaking out for fear of becoming a future target. When we meet with families who have a belief in honor killings, we can discuss how patriarchal societies have encouraged families to maintain a firm hand on the behavior of their members. This practice encourages repression of women’s individuality and also may consider women to be possessions. Patriarchal societies control their populations by supporting values and beliefs in their citizens that support the patriarchal structure. In this way, they can exert social control easily by having members of the society act as enforcers. Open and clear discussion with families about the ways in which cultural practice affects individual behavior may allow families that are unsure to explore alternative new beliefs.

Families must understand that, under U.S. law, perpetrators of honor killings and domestic violence can be prosecuted.

• System change. According to the U.S. Justice Department, 9 out of 10 honor killings were victims who had become “too Westernized.” Leaders of the American Muslim community and members of the Council on American-Islamic Relations have condemned all honor killings, stating that the practice stems from sexism and tribal behavior that predates the religion. In February 2009, after the high-profile killing of Aasiya Zubair Hassan in New York, Muslim leaders began a nationwide effort entitled, “Imams Speak Out: Domestic Violence Will Not Be Tolerated in Our Communities,” asking all imams and religious leaders to discuss domestic violence in their weekly sermon or their Friday prayer services. The group, “Muslim Men Against Domestic Violence,” was founded soon after the murder, which came just a few days after she had filed for divorce. (After a 3-week trial, Mrs. Hassan’s estranged husband, Muzzammil “Mo” Hassan, was found guilty of second-degree murder and received a 25-year to life sentence).

Our laws reflect our values as a society. As citizens, we must actively work for the enforcement of domestic violence laws. Our mental health organizations can support the training of police and health agencies to identify victims and perpetrators.

References

1. The World Factbook, Central Intelligence Agency, 2009.

2 Forensic Sci Med Pathol. 2014;10(1):76-82.

3. “Lives Together, Worlds Apart: Men and Women in a Time of Change,” United Nations Population Fund report, 2000.

4. “Pakistan’s Honor-Killing Law Isn’t Enough,” The New York Times, Oct. 27, 2016.

5. “Controlling or Coercive Behaviour in an Intimate or Family Relationship,” Home Office, December 2015.

Dr. Heru is professor of psychiatry at the University of Colorado Denver, Aurora. She is editor of “Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals” (New York: Routledge, 2013). She has no conflicts of interest to disclose.

 

As healers trained to address some of the psychosocial issues facing our patients, we need to understand various forms of domestic violence – and what we can do to stop it. One form, honor killings, remains pervasive across the globe.

In a sample of 856 ninth-grade students from 14 schools in Amman, Jordan, for example, about 40% of boys and 20% of girls believed that killing a daughter, sister, or wife who had dishonored the family was justified (Aggress Behav. 2013 Sep-Oct;39[5]:405-17). The schools were representative of students from different religions, socioeconomic statuses, and upbringings. The proportions are broadly in line with the religious affiliation of Jordanians, with 92% of the population identifying themselves as Muslims, 6% as Christians, and 2% as affiliated with other religions.1 However, researchers found that support for honor killings was more widespread among adolescents from poorer and more traditional family backgrounds.

Those findings are in accord with those from studies on related topics such as wife beating, which also is more prevalent among the less educated and traditional groups of Middle Eastern societies. However, neither religion nor the intensity of religious beliefs was a significant predictor of attitudes toward honor crimes. This supports the theory that honor killings do not depend on a specific religious background; rather, they depend upon patriarchy, family honor, and the preservation of female virginity as prominent values. Jordan is considered modern by Middle Eastern standards, so the high proportion of young people with supportive attitudes about honor killing is concerning.

What are honor killings?

According to Sally Elakkary, MD, and her colleagues, honor killings are “violence implicated against a female for the deviancy of her activities from the traditional cultural norms.”2 The perpetrators in these crimes are usually male relatives but may be other family members, including women. Males also can be victims of honor crimes. For example, a male can become a victim if he is the female’s lover in an extramarital relationship or if he is homosexual.

Most honor killings are reported from countries in the Maghreb region of North Africa; the Middle East (Palestine, Lebanon, Syria, Jordan, and Turkey); and Western and Central Asia (Iraq, Pakistan, Afghanistan, and India). However, honor killings also occur in countries with strong minorities from those origins. A report3 published in 2000 by the United Nations Population Fund estimated that 5,000 honor killings were carried out worldwide per year, with the largest absolute numbers reported for Pakistan and India (about 1,000 cases per year in each country).

Until the 1960s in the United States, penal codes in some states, such as Georgia, New Mexico, Texas, and Utah, justified a husband killing his wife’s lover. In those states, the law was formulated to protect the male’s honor. Honor killings are culture-based practices that are supported indirectly by that country’s legal system. In a recent New York Times op-ed4 piece, Bina Shah stated that “upending misogynistic tribal codes is the real key to finally ending the most egregious gender crime.” The Pakistan Parliament recently stiffened the punishment for honor killings. The new anti–honor killing law mandates a minimum lifetime jail sentence for perpetrators and closes a legal loophole that allowed an honor killer to walk free if the family of the victim forgave him.

However, in rural areas, a Pakistani woman accused of violating family or tribal honor can be sentenced to death by an informal village court or a gathering of tribal elders. Women have been killed by stoning, shooting, or being buried alive. Sometimes, the woman’s relatives condemn her to death without a trial. Women are killed for reasons such as wanting to marry of their own choice, divorcing abusive husbands, or speaking to a man or boy outside the family; “in one case, four young girls who were filmed dancing in a rain shower were executed by their cousin for immorality,” Ms. Shah said.

Range of behaviors

Abusive behavior can take many forms, including:

• Isolating a person from her friends and family.

• Depriving her of basic needs.

• Monitoring her time.

• Monitoring her use of online communication tools or spyware.

• Taking control over aspects of her everyday life, such as where she can go, whom she can see, what she can wear, and when she can sleep.

• Depriving her of access to support services, such as specialist support or medical services.

• Repeatedly putting her down, such as telling her that she is worthless.

• Enforcing rules and activities that humiliate, degrade, or dehumanize the victim.

• Forcing the victim to take part in criminal activity such as shoplifting, and neglecting or abusing children to encourage self-blame and prevent disclosure to authorities.

• Abusing finances, including controlling resources so that the person is allowed only a punitive allowance.

• Threatening to hurt or kill her.

• Threatening a child.

• Threatening to reveal or publish private information (for example, threatening to “out” someone).

• Assaulting the person.

• Causing criminal damage (such as destruction of household goods).

• Engaging in rape.

• Preventing a person from having access to transportation or from working.

 

New domestic violence law in the United Kingdom

Meanwhile, domestic violence laws in England and Wales now consider emotional and psychological abuse as legally actionable. The new legislation targets those who subject spouses, partners, and family members to psychological and emotional torment, but stop short of violence. The new law5 follows a Home Office consultation showing that 85% of participants said the existing law did not provide sufficient protection and a Citizens Advice report showing a 24% rise in people seeking advice for domestic abuse.

The new law falls under the Serious Crime Act 2015 of England and Wales. The act creates a new offense of “controlling or coercive behavior in intimate or familial relationships.” The act states: “The new offence closes a gap in the law around patterns of controlling or coercive behavior in an ongoing relationship between intimate partners or family members.”

Breaking the law carries a maximum sentence of 5 years’ imprisonment, a fine, or both. The behavior must have had a “serious effect” on the victim, meaning that it has caused the victim to fear violence will be used against them on “at least two occasions,” or it has had a “substantial adverse effect on the victim’s day to day activities.”

The alleged perpetrator must have known that his behavior would have a serious effect on the victim, or the behavior must have been such that he “ought to have known” it would have that effect.

The new law includes honor-based violence, female genital mutilation, and forced marriage. The law explicitly states that the victim may fear that the perpetrator has asked another person to commit violence against them, thus including family honor killings.

Gendered nature of domestic controlling or coercive behavior

While all legislation is gender neutral, women and girls are disproportionately affected by crimes of domestic violence and abuse. Women from black and minority ethnic backgrounds may experience barriers to reporting, such as a distrust of the police, concerns about racism, language barriers, concerns about family finding out, or fear of rejection by the wider community. A victim might be fearful about her children being taken away if she makes a report. Lesbian, gay, bisexual, and transgender individuals in relationships may be subjected to threats to reveal sexual orientation to family or others.

Interestingly, the U.K. guidelines state that victims of controlling or coercive behavior may not recognize themselves as victims. Therefore, it is important that the new offense be considered by the police and other authorities in attendance at all call-outs. Police are encouraged to ask questions about rules, decision making, norms, and fear in the relationship, rather than just what happened. The guidelines provide specific comments about handling perpetrators who are described as being “particularly adept” at manipulating professionals, agencies, and systems, and may use a range of tactics in relation to this offense, including targeting people who might be vulnerable (there may be evidence of this from previous relationships) and using the system against the victim by making false or vexatious allegations to agencies.

The Authorized Professional Practice on Investigating Domestic Abuse issued by the College of Policing states: “A manipulative perpetrator may be trying to draw the police into colluding with their coercive control of the victim. Police officers must avoid playing into the primary perpetrator’s hands and take account of all available evidence when making the decision to arrest.” Such evidence includes attempting to frustrate or interfere with the police investigation; making counterallegations against the victim; and using threats of manipulation against the victim – such as telling the victim that he will make a counterallegation against her, that the victim will not be believed by the police or other agencies, that he will inform social services, or that he will inform immigration officials where the victim does not have a right to remain.

How can psychiatrists raise awareness?

• Individual change. Abusive controlling behavior can have its origin in childhood psychological experiences, in the same way that honor killings and wife beating can have their roots in the perpetrator’s cultural experience. As a child, the adult perpetrator may have been a direct victim of violence or may have been a witness to domestic violence. Controlling abusive behavior also can occur as a choice in perpetrators with personality disorders unrelated to childhood experiences. It can occur in a person with both exposure and personality disorder. It is important to understand the origins and reasoning behind the behavior in order to understand how best to intervene.

If the behavior is based on the childhood experience of the prevailing sociocultural practice, the psychiatrist can explore values and beliefs, identifying those that are based on family and cultural factors. Beliefs that have been present during a person’s entire life can appear as the unexamined “background” of their lives. Bringing those beliefs to the fore can allow discussion. For example, does the individual hold the belief that women are possessions? What is the basis of holding such a belief? How does he account for the differences between societies?

 

• Family change. Individuals in the family may differ in their support of honor killings. Those who do not support honor killings may have difficulty speaking out for fear of becoming a future target. When we meet with families who have a belief in honor killings, we can discuss how patriarchal societies have encouraged families to maintain a firm hand on the behavior of their members. This practice encourages repression of women’s individuality and also may consider women to be possessions. Patriarchal societies control their populations by supporting values and beliefs in their citizens that support the patriarchal structure. In this way, they can exert social control easily by having members of the society act as enforcers. Open and clear discussion with families about the ways in which cultural practice affects individual behavior may allow families that are unsure to explore alternative new beliefs.

Families must understand that, under U.S. law, perpetrators of honor killings and domestic violence can be prosecuted.

• System change. According to the U.S. Justice Department, 9 out of 10 honor killings were victims who had become “too Westernized.” Leaders of the American Muslim community and members of the Council on American-Islamic Relations have condemned all honor killings, stating that the practice stems from sexism and tribal behavior that predates the religion. In February 2009, after the high-profile killing of Aasiya Zubair Hassan in New York, Muslim leaders began a nationwide effort entitled, “Imams Speak Out: Domestic Violence Will Not Be Tolerated in Our Communities,” asking all imams and religious leaders to discuss domestic violence in their weekly sermon or their Friday prayer services. The group, “Muslim Men Against Domestic Violence,” was founded soon after the murder, which came just a few days after she had filed for divorce. (After a 3-week trial, Mrs. Hassan’s estranged husband, Muzzammil “Mo” Hassan, was found guilty of second-degree murder and received a 25-year to life sentence).

Our laws reflect our values as a society. As citizens, we must actively work for the enforcement of domestic violence laws. Our mental health organizations can support the training of police and health agencies to identify victims and perpetrators.

References

1. The World Factbook, Central Intelligence Agency, 2009.

2 Forensic Sci Med Pathol. 2014;10(1):76-82.

3. “Lives Together, Worlds Apart: Men and Women in a Time of Change,” United Nations Population Fund report, 2000.

4. “Pakistan’s Honor-Killing Law Isn’t Enough,” The New York Times, Oct. 27, 2016.

5. “Controlling or Coercive Behaviour in an Intimate or Family Relationship,” Home Office, December 2015.

Dr. Heru is professor of psychiatry at the University of Colorado Denver, Aurora. She is editor of “Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals” (New York: Routledge, 2013). She has no conflicts of interest to disclose.

 

As healers trained to address some of the psychosocial issues facing our patients, we need to understand various forms of domestic violence – and what we can do to stop it. One form, honor killings, remains pervasive across the globe.

In a sample of 856 ninth-grade students from 14 schools in Amman, Jordan, for example, about 40% of boys and 20% of girls believed that killing a daughter, sister, or wife who had dishonored the family was justified (Aggress Behav. 2013 Sep-Oct;39[5]:405-17). The schools were representative of students from different religions, socioeconomic statuses, and upbringings. The proportions are broadly in line with the religious affiliation of Jordanians, with 92% of the population identifying themselves as Muslims, 6% as Christians, and 2% as affiliated with other religions.1 However, researchers found that support for honor killings was more widespread among adolescents from poorer and more traditional family backgrounds.

Those findings are in accord with those from studies on related topics such as wife beating, which also is more prevalent among the less educated and traditional groups of Middle Eastern societies. However, neither religion nor the intensity of religious beliefs was a significant predictor of attitudes toward honor crimes. This supports the theory that honor killings do not depend on a specific religious background; rather, they depend upon patriarchy, family honor, and the preservation of female virginity as prominent values. Jordan is considered modern by Middle Eastern standards, so the high proportion of young people with supportive attitudes about honor killing is concerning.

What are honor killings?

According to Sally Elakkary, MD, and her colleagues, honor killings are “violence implicated against a female for the deviancy of her activities from the traditional cultural norms.”2 The perpetrators in these crimes are usually male relatives but may be other family members, including women. Males also can be victims of honor crimes. For example, a male can become a victim if he is the female’s lover in an extramarital relationship or if he is homosexual.

Most honor killings are reported from countries in the Maghreb region of North Africa; the Middle East (Palestine, Lebanon, Syria, Jordan, and Turkey); and Western and Central Asia (Iraq, Pakistan, Afghanistan, and India). However, honor killings also occur in countries with strong minorities from those origins. A report3 published in 2000 by the United Nations Population Fund estimated that 5,000 honor killings were carried out worldwide per year, with the largest absolute numbers reported for Pakistan and India (about 1,000 cases per year in each country).

Until the 1960s in the United States, penal codes in some states, such as Georgia, New Mexico, Texas, and Utah, justified a husband killing his wife’s lover. In those states, the law was formulated to protect the male’s honor. Honor killings are culture-based practices that are supported indirectly by that country’s legal system. In a recent New York Times op-ed4 piece, Bina Shah stated that “upending misogynistic tribal codes is the real key to finally ending the most egregious gender crime.” The Pakistan Parliament recently stiffened the punishment for honor killings. The new anti–honor killing law mandates a minimum lifetime jail sentence for perpetrators and closes a legal loophole that allowed an honor killer to walk free if the family of the victim forgave him.

However, in rural areas, a Pakistani woman accused of violating family or tribal honor can be sentenced to death by an informal village court or a gathering of tribal elders. Women have been killed by stoning, shooting, or being buried alive. Sometimes, the woman’s relatives condemn her to death without a trial. Women are killed for reasons such as wanting to marry of their own choice, divorcing abusive husbands, or speaking to a man or boy outside the family; “in one case, four young girls who were filmed dancing in a rain shower were executed by their cousin for immorality,” Ms. Shah said.

Range of behaviors

Abusive behavior can take many forms, including:

• Isolating a person from her friends and family.

• Depriving her of basic needs.

• Monitoring her time.

• Monitoring her use of online communication tools or spyware.

• Taking control over aspects of her everyday life, such as where she can go, whom she can see, what she can wear, and when she can sleep.

• Depriving her of access to support services, such as specialist support or medical services.

• Repeatedly putting her down, such as telling her that she is worthless.

• Enforcing rules and activities that humiliate, degrade, or dehumanize the victim.

• Forcing the victim to take part in criminal activity such as shoplifting, and neglecting or abusing children to encourage self-blame and prevent disclosure to authorities.

• Abusing finances, including controlling resources so that the person is allowed only a punitive allowance.

• Threatening to hurt or kill her.

• Threatening a child.

• Threatening to reveal or publish private information (for example, threatening to “out” someone).

• Assaulting the person.

• Causing criminal damage (such as destruction of household goods).

• Engaging in rape.

• Preventing a person from having access to transportation or from working.

 

New domestic violence law in the United Kingdom

Meanwhile, domestic violence laws in England and Wales now consider emotional and psychological abuse as legally actionable. The new legislation targets those who subject spouses, partners, and family members to psychological and emotional torment, but stop short of violence. The new law5 follows a Home Office consultation showing that 85% of participants said the existing law did not provide sufficient protection and a Citizens Advice report showing a 24% rise in people seeking advice for domestic abuse.

The new law falls under the Serious Crime Act 2015 of England and Wales. The act creates a new offense of “controlling or coercive behavior in intimate or familial relationships.” The act states: “The new offence closes a gap in the law around patterns of controlling or coercive behavior in an ongoing relationship between intimate partners or family members.”

Breaking the law carries a maximum sentence of 5 years’ imprisonment, a fine, or both. The behavior must have had a “serious effect” on the victim, meaning that it has caused the victim to fear violence will be used against them on “at least two occasions,” or it has had a “substantial adverse effect on the victim’s day to day activities.”

The alleged perpetrator must have known that his behavior would have a serious effect on the victim, or the behavior must have been such that he “ought to have known” it would have that effect.

The new law includes honor-based violence, female genital mutilation, and forced marriage. The law explicitly states that the victim may fear that the perpetrator has asked another person to commit violence against them, thus including family honor killings.

Gendered nature of domestic controlling or coercive behavior

While all legislation is gender neutral, women and girls are disproportionately affected by crimes of domestic violence and abuse. Women from black and minority ethnic backgrounds may experience barriers to reporting, such as a distrust of the police, concerns about racism, language barriers, concerns about family finding out, or fear of rejection by the wider community. A victim might be fearful about her children being taken away if she makes a report. Lesbian, gay, bisexual, and transgender individuals in relationships may be subjected to threats to reveal sexual orientation to family or others.

Interestingly, the U.K. guidelines state that victims of controlling or coercive behavior may not recognize themselves as victims. Therefore, it is important that the new offense be considered by the police and other authorities in attendance at all call-outs. Police are encouraged to ask questions about rules, decision making, norms, and fear in the relationship, rather than just what happened. The guidelines provide specific comments about handling perpetrators who are described as being “particularly adept” at manipulating professionals, agencies, and systems, and may use a range of tactics in relation to this offense, including targeting people who might be vulnerable (there may be evidence of this from previous relationships) and using the system against the victim by making false or vexatious allegations to agencies.

The Authorized Professional Practice on Investigating Domestic Abuse issued by the College of Policing states: “A manipulative perpetrator may be trying to draw the police into colluding with their coercive control of the victim. Police officers must avoid playing into the primary perpetrator’s hands and take account of all available evidence when making the decision to arrest.” Such evidence includes attempting to frustrate or interfere with the police investigation; making counterallegations against the victim; and using threats of manipulation against the victim – such as telling the victim that he will make a counterallegation against her, that the victim will not be believed by the police or other agencies, that he will inform social services, or that he will inform immigration officials where the victim does not have a right to remain.

How can psychiatrists raise awareness?

• Individual change. Abusive controlling behavior can have its origin in childhood psychological experiences, in the same way that honor killings and wife beating can have their roots in the perpetrator’s cultural experience. As a child, the adult perpetrator may have been a direct victim of violence or may have been a witness to domestic violence. Controlling abusive behavior also can occur as a choice in perpetrators with personality disorders unrelated to childhood experiences. It can occur in a person with both exposure and personality disorder. It is important to understand the origins and reasoning behind the behavior in order to understand how best to intervene.

If the behavior is based on the childhood experience of the prevailing sociocultural practice, the psychiatrist can explore values and beliefs, identifying those that are based on family and cultural factors. Beliefs that have been present during a person’s entire life can appear as the unexamined “background” of their lives. Bringing those beliefs to the fore can allow discussion. For example, does the individual hold the belief that women are possessions? What is the basis of holding such a belief? How does he account for the differences between societies?

 

• Family change. Individuals in the family may differ in their support of honor killings. Those who do not support honor killings may have difficulty speaking out for fear of becoming a future target. When we meet with families who have a belief in honor killings, we can discuss how patriarchal societies have encouraged families to maintain a firm hand on the behavior of their members. This practice encourages repression of women’s individuality and also may consider women to be possessions. Patriarchal societies control their populations by supporting values and beliefs in their citizens that support the patriarchal structure. In this way, they can exert social control easily by having members of the society act as enforcers. Open and clear discussion with families about the ways in which cultural practice affects individual behavior may allow families that are unsure to explore alternative new beliefs.

Families must understand that, under U.S. law, perpetrators of honor killings and domestic violence can be prosecuted.

• System change. According to the U.S. Justice Department, 9 out of 10 honor killings were victims who had become “too Westernized.” Leaders of the American Muslim community and members of the Council on American-Islamic Relations have condemned all honor killings, stating that the practice stems from sexism and tribal behavior that predates the religion. In February 2009, after the high-profile killing of Aasiya Zubair Hassan in New York, Muslim leaders began a nationwide effort entitled, “Imams Speak Out: Domestic Violence Will Not Be Tolerated in Our Communities,” asking all imams and religious leaders to discuss domestic violence in their weekly sermon or their Friday prayer services. The group, “Muslim Men Against Domestic Violence,” was founded soon after the murder, which came just a few days after she had filed for divorce. (After a 3-week trial, Mrs. Hassan’s estranged husband, Muzzammil “Mo” Hassan, was found guilty of second-degree murder and received a 25-year to life sentence).

Our laws reflect our values as a society. As citizens, we must actively work for the enforcement of domestic violence laws. Our mental health organizations can support the training of police and health agencies to identify victims and perpetrators.

References

1. The World Factbook, Central Intelligence Agency, 2009.

2 Forensic Sci Med Pathol. 2014;10(1):76-82.

3. “Lives Together, Worlds Apart: Men and Women in a Time of Change,” United Nations Population Fund report, 2000.

4. “Pakistan’s Honor-Killing Law Isn’t Enough,” The New York Times, Oct. 27, 2016.

5. “Controlling or Coercive Behaviour in an Intimate or Family Relationship,” Home Office, December 2015.

Dr. Heru is professor of psychiatry at the University of Colorado Denver, Aurora. She is editor of “Working With Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals” (New York: Routledge, 2013). She has no conflicts of interest to disclose.